Wendover, Ronald Wayne -4 23y
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Ronald Wayne Wendover Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/12.2022 67 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death a NaturalCause Accident El Homicide Suicide Undetermined ElPending
W U Circumstances Investigation
Q Medical Certifier Name Title
Gamal Khalifa MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 159
Burial Date Cemetery,Crematory or Facility Name
111101111 03/14/2022 Pine View Crematorium
Entombment Address
®Cremation Queensbury Town,New York
Donation
Z 1-1 Date Place Removed
Removal
and/or and/or Held
F Hold Address
N
0
CL Date Point of
(/)❑Transportation
p by Common Shipment
Carrier Destination
El
Disinterment
Date Cemetery Address
Date Cemetery Address
Re.imerment
Permit Issued to Registration Number
Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141
Address
9 Pine St,Chestertown, New York 12817
Name of Funeral Firm Making Disposition or to Whom
f— Remains are Shipped,If Other than Above
Address
CC
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/14/2022 Registrar of Vital Statistics Megan tolrn(Elaro/tha/1'Si,ne1O
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition 11 1 S 17 2, Place of Disposition
2 (address)
W
CC CC (section) (lot number) (grave number)
CIName of Sexton or Person in C rge of Premise !el -' �in�1l�
Z please print/
Signature Title (01410(
DOH 1555(o//i8)p i of 2
r r
Public Health Law Sec. 4145(2b) 1" '`
Receipt
Human remains of delivered on 1 ,
20
Pine View Cemetery Representing the funeral home named 0n,burial-perwit
Official Funeral Directors Reg.or License#