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Wade, George Waldo NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex George Waldo Wade Male Date of Death Age If Veteran of U.S.Armed Forces, 07/15/2023 70 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Village Street Address 16 Center Street Apt.C,Fort Edward Village,New York 12828 W Manner of Death n Undetermined Pending Natural Cause Accident I I Homicide Suicide W Circumstances Investigation W Medical Certifier Name Title Scott Miller PA Address 100 Park St,Glens Falls, New York 12801 Death Certificate Filed Town Of Fort Edward District Number Register Number City,Town or Village 5755 61 Burial Date Cemetery,Crematory or Facility Name 07/18/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held F Hold Address CO O G. Date Point of to Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address 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 I Remains are Shipped,If Other than Above 2 Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/18/2023 Registrar of Vital Statistics Aimee L ifalioney(ECectronicaCCy Signed) (signature) District Number 5755 Place Town Of Fort Edward I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F— �f Z Date of Disposition 1 1(q1 Z3 Place of Disposition 1„.AL W (address) W N CC (section) (lot number) (grave number) ` G Name of Sexton or Person in Charge of P ises Z (please print) W Signature Title t(l�f>rYlt� DOH-1555(o7/18)p 1 of 2 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#