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Wood Sr., Lester John ©. it IA (,( NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Lester John Wood Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 05/19/2023 75 Years War or Dates ▪ Place of Death Hospital,Institution or W City,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing O Manner of Death EINatural CauseAccident 0 Homicide Suicide FlUndetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title O Joshua Started NP Address 10421 State Route 40,Granville Town,New York 12832 Death Certificate Filed Town Of Granville District Number Register Number City,Town or Village 5756 30 Burial Date Cemetery,Crematory or Facility Name 05/23/2023 Pine View Crematorium Entombment _ Address ©Cremation Queensbury Town, New York ElDonation 0 Removal Date Place Removed - and/or and/or Held F- Hold Address N 0 0.. Date Point of if/) Transportation Shipment G by Common Carrier Destination Disintermento Cemetery Address Date 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 • Address ir a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/22/2023 Registrar of Vital Statistics Jenny Linda M MarteC(e(E(ectronica(Cy Signed) (signature) District Number 5756 Place Town Of Granville I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition 5-123)Z3 Place of Disposition(„ 2 (address) W I ) C (section) I f (lot number) (grave number) 0 Name of Sexton or Person in Charge o ern' ^tQ� {If Z ease print) tIJ Signature Title I �� DOH-1555(07/18)p 1 of 2 V r_ dp 3 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#