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Wilcox. Wayne Oliver 2 iq N EW YORK STATE DEPARTMENT OF HEALTHTransit Permit Bureau of Vitat Records Burial - Name First Middle Last Sex Wayne Oliver Wilcox Male Date of Death Age If Veteran of U.S.Armed Forces, 03/03/2023 85 Years War or Dates 1960-64 Place of Death Hospital,Institution or W City,Town or Village Albany Street Address Albany Medical Center Hospital p Manner of Death ❑Natural Cause Accident Homicide OSuicide Undetermined Pending W C.) Circumstances Investigation W Medical Certifier Name Title CI Antonio Sturges Coroner Address 175 Green Street,Albany,New York 12202 Death Certificate Filed City Of Albany District Number Register Number City,Town or Village 0101 0558 Burial Date Cemetery,Crematory or Facility Name 03/07/2023 Pine View Crematory _Entombment Address ©Cremation Queensbury Town,New York Donation z❑Removal Date Place Removed and/or and/or Held Hold Address 0 Ct. Date Point of Cl)❑Transportation Shipment by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom �. Remains are Shipped,If Other than Above 2 Address CC LU Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/06/2023 Registrar of Vital Statistics Danielle S ci(Cespie(ECectronicalCy Signed) (signature) District Number 0101 Place City Of Albany I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 3I g lz; Place of Disposition Fits•4 (address) W t,nCC (section) l (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premis ' i— 1 /ple se print/W Signature {' EE1? l¢Fmlf ! Title DOH-1555(07/18)p i of 2 .,F .._.U 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#