Armstrong, Wanda Jane ( 27?
NEW YORKSTATE DEPARTMENT OF HEALTH \ �'— /
Bureau of Vital Records ___e Burial - Transit Permit
Name First Middle Last Sex
Wanda Jane Armstrong Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/10/2022 76 Years War or Dates
i.: Place of Death Hospital,Institution or
Z City,Town or Village Chester Town Warren Street Address 52 Palmer Pond Road,Chester Town Warren,New York 12817
11.1
a Manner of Death El Natural Cause Accident ❑Homicide Suicide Undetermined ElPending
ILI
t)0 Circumstances Investigation
ii Medical Certifier Name Title
0 Ryan Donnelly DO
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Chester District Number Register Number
City,Town or Village 5652 12
Burial Date Cemetery,Crematory or Facility Name
09/14/2022 Pine View Crematory
Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
N
Hold Address
0
a Date Point of
U)❑Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
1- Remains are Shipped,If Other than Above
5 Address
CC
LL)
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/13/2022 Registrar of Vital Statistics Mindy Conway(ECectronicalty Signed)
(signature)
District Number 5652 Place Town Of Chester
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: //
Z Date of Disposition y IN17Z Place of Disposition Fat
W
2 (address)
W
CC CC (section) (lot number) Si,,,Avit (grave number)
g Name of Sexton or Person in Charge of Premises r'
l
/p/e a print)
Z (196111 f111�ir'�
t)J Signature Title
DOH-1555(o7/18)p 1 of 2
M
Public Health Law Sec. 4145(2b) ... ..
1 Receipt
I P.
Human remains of I a delivered on , 20
F
/r.'A.
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License# Y