Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Scoville, Wayne Scott
LF NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Wayne Scott Scoville Male Date of Death Age If Veteran of U.S.Armed Forces, 11/25/2023 62 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death El Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation WMedical Certifier Name Title Salam Hawa MD 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 549 Burial Date Cemetery,Crematory or Facility Name 11/29/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation goRemoval Date Place Removed and/or and/or Held ~ Hold Address CO 0 O. Date Point of N Transportation p by Common Shipment Carrier Destination O Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above Address W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/27/2023 Registrar of Vital Statistics Megan 9troRsn gkctronically.Stgne9 (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 IZ I 1 Z3 Place of Disposition -� 2 (address/ W NCC (section) (tot`umber/ _ (grave number) S Name of Sexton or Person in Charge, Premises 6Z4* lb Z ( ease print/ r Re W Signatures Title 4 DOH-1555(07/18)p t of 2 • Public Health Law Sec. 4145(2b) r r7 '. Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#