WadeWard, Deborah Arlene HEALTH1.4,F ermit
NEW YORK STATE DEPARTMENT OFBurial - Transit P
Bureau of Vital Records
Name First Middle Last Sex
Deborah Arlene Wade-Ward Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/19/2022 69 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
• Manner of Death El Natural Cause Accident Homicide Suicide ❑
Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
O Matthew Loftus PA
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 275
Burial Date Cemetery,Crematory or Facility Name
05/20/2022 Pine View Crematorium
Entombment Address
aCremation Queensbury Town,New York
DDonation
0❑Removal Date Place Removed
and/or and/or Held
CO
Hold Address
O. Date Point of
t/)❑Transportation Shipment
p by Common
Carrier Destination
El
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
a Address
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/19/2022 Registrar of Vital Statistics MeganNolin(E(ectronicaltySigned)
(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:
Z
W Date of Disposition S 2/2071 Place of Disposition p ,,1 e 1f.�Pru.� C1'opi 4
(address)
IW
Q (section) ( t num er) (grave number)
8 Name of Sexton or Person in Charge Premiss d�� it v
(please print)
IU Signature ij�'� / fr Title r
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on < , , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#