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Wendell, Jason Matthew # (oty.) (tts NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jason Matthew Wendell Male Date of Death Age If Veteran of U.S.Armed Forces, 08/06/2023 52 Years War or Dates 88-91 i,.., Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Village Street Address 62 Broadway,Fort Edward Village,New York 12828 11.1 a 11]Natural Cause []Accident []Homicide Suicide []ILI [] Manner of Death Undetermined Pending Circumstances Investigation W Medical Certifier Name Title 0 Robert Lemieux Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed Town Of Fort Edward District Number Register Number City,Town or Village 5755 70 EBurial Date Cemetery,Crematory or Facility Name 08/08/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Z❑Removal Date Place Removed and/or and/or Held H Hold Address U) 0 a. Date Point of U)[]Transportation Q by Common Shipment Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address C Reinterment 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 g Address CC W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/07/2023 Registrar of Vital Statistics Ainee L alalroneygkctronicall:y Slgner) (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: IH- Z Date of Disposition ell i 13 Place of Disposition •r:41` r--.. W 2 (address) ILl Cl)CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Prem. es t� H Z ease print) /' W Signature Title /6 474 DOH-1555(o7/18)p 1 of 2 IJ '. i , k Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing thO'funeral home named on burial permit Official Funeral Directors Reg. or License#