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Wood, Kathleen J
NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records BUrlal - Transit Permit Name First Middle Last Sex Kathleen J Wood Female Date of Death Age If Veteran of U.S.Armed Forces, 10/01/2023 87 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 0 Manner of Death ZNatural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title 0 Shahid Ahmed MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 457 RBurial Date Cemetery,Crematory or Facility Name ,, 10/04/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed F and/or and/or Held __ N Hold Address WOTransportation Date Point of p by Common Shipment Carrier Destination Disinterment Date Cemetery Address 0 Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom F— Remains are,Shipped,If Other than Above a Address CIC O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/04/2023 Registrar of Vital Statistics Megan No(n(ECectronicalTy 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: Date of Disposition /6-6-ZoZ 5 Place of Disposition e ni Q iii.) C nk'o 1is LU 2 (address) W NCr (section) (lot number i (grave number) 0 Name of Sexton or Person in Charg Premis 1� AY/'?d nJ J ODLi (please print) Z /� am/ W Signature ��-yy Title 0.4,-(74- DOH-1555(07/18)p 1 of 2 G' 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#