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Wood, Rose Marie
NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records .•- Burial - Transit Permit Name First Middle Last Sex Rose Marie Wood Female Date of Death Age If Veteran of U.S.Armed Forces, 06/10/2023 81 Years War or Dates H• Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death El Natural Cause Accident Homicide Suicide Undetermined ❑Pending W Circumstances Investigation WQ Medical Certifier Name Title Shannon Evellis PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 295 Burial Date Cemetery,Crematory or Facility Name 06/13/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Removal Date Place Removed H and/or and/or Held N Hold Address 0 Q. Date Point of N EITransportation p by Common Shipment Carrier Destination ODisinterment Date Cemetery Address 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 H Remains are Shipped,If Other than Above Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/12/2023 Registrar of Vital Statistics Megan.No(in(ECectronicatTy Signed) (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 Date of Disposition (p lik f h Place of Disposition 2 (address) W CC N (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premis i �� Z (pease print/ IU Signature Title (WIN(�� DOH-1555(07/18)p t of 2 1703q Public Health Law Sec. 4145(2b) Receipt Human remains of deliyered on , 20 Pine•View Cemetery Representing the funeral home named on byrjtl permit Official Funeral Directors Reg.or License#