Wrigley, Douglas A NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Douglas A.Wrigley Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/01/2022 102 Years War or Dates 1944-1946
I— Place of Death Ilospital,Institution or
Z City,Town or Village Saratoga Springs Street Address 35 New Street,Saratoga Springs,New York 12866
W Manner of Death EINatural CauseEAccidentHomicide Suicide ❑Undetermined ❑Pending
Circumstances Investigation
W Medical.Certifier Name Title
O Matthew Pender MD
Address
35 Gilbert Street,Cambridge Village,New York 12816
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 575
X Burial
E Date Cemetery,Crematory or Facility Name
10/07/2022 Pine View Cemetery
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
6— Hold Address
0
O. Date Point of
U'❑Transportation
CI by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Ackley,Ross&Gariepy Funeral Home 00020
Address
73 W Main St,Cambridge,New York 12816
Name of Funeral Firm Making Disposition or to Whom
i}— Remains are Shipped,If Other than Above
2 Address
Cr
W
• Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/03/2022 Registrar of Vital Statistics DrllmNowt( '4etrorrrc .S/neJJ
(signature)
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Date of Disposition 16,"\ . Da Place of Disposition j l 41 tri £ 1c X\ �\ }'{d I
UJ
2 (address) r�
lw CY-1( -Ni calm '-a3-E
U)
L): (se lion) ,b(lot number) (grave number)
8 Name of Sexton or Person in Charge of Premises �nf-'le ���c� �'\--• •
Zr (please print)
LU
Signature • Title Jul<--.�(—1 C, len.\ -N-
4.
D011 1555(o)/t8)p t of 2
Public Health Law Sec. 4145(2b) 012945
Receipt
Human remains of delivered on i , 20
iz
( JJ i. t_ -- L / Ii
it
!life View Cemetery Representing the funeral home named on burial permit
official Funeral Directors Reg.or License# "
WRIGLEY
NAME Douglas A Wrigley Age: 102
Lot Owner: Douglas Wrigley
Lot# Mohican 43 E Grave# 1
Case: Concrete
Died: 1 0. 1 .2 2 Interred: 1 0. 7.2 2
Funeral Home: Ackley, Ross & GAriepy FH
Cemetery: Pine View
Wrigley
Lot No. 43-E
ddress 29 Marcy Lane Queensbury NY 12804 Section No.
owner Douglas Wrigley Plot Mohican
late 8/1/95
Approx. 6 7Superficial ft. @
,ovation Bounded North by Vacant , South by Robelen , East by Bowen , West by Vacant ,
;orner Posts
remarks
)eed No. (and changes) 2682
'ayment Record Paid in Full 8/1/95 ( $7 0 0 . 0 0 )
record of Interments c)f). \ l a Q V A-C ,.I
A 1)LN,Rx e11 -, 10 ? k
Virginia A. Wrigley 4/1/95 V W
-A Andrew Wrigley 4/30/96 S fv
T
U
' � 1 . 2
O N
Form No. 01