Atwood, Judith NEW YORK STATE DEPARTMENT OF HEALTH LF Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Judith H.Atwood Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/20/2024 79 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Poughkeepsie Town Street Address Lutheran Center Poughkeepsie
IJJ
VpManner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
C Amjad lqbal MD
Address
965 Dutchess Tpke,Poughkeepsie Town,New York 12603
Death Certificate Filed Town Of Poughkeepsie District Number Register Number
City,Town or Village 1363 25
L Burial Date Cemetery,Crematory or Facility Name
01/26/2024 Pineview Cemetery
Entombment
_ Address
Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
0- Date Point of
(/)OTransportation
El Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home William G Miller&Son Funeral Home Inc 01825
Address
371 Hooker Ave,Poughkeepsie,New York 12603
Name of Funeral Firm Making Disposition or to Whom
F.. Remains are Shipped,If Other than Above
2 Address
CC
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/23/2024 Registrar of Vital Statistics `Felicia Lee Salvatore(E(ectronicallySigned)
(signature)
District Number 1363 Place Town Of Poughkeepsie
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
Ill Date of Disposition al>7 as Place of Disposition \ ucak {�-,-- (.:_ uK—s-1`sj
2 (address)
N vL h=sa kI-Li IC\ Ql- ►�q 3 \
CC ion) (lot number) (grave number)
gName of Sexton or Person in Charge of Premis %Th - ---(3C
Z (please print)
W Signature ,41 tA.� oe I' Title es.-* ��ArNACS\-t—
DOH-1555(07/18)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# -
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t-= Lot No.
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ddress 13 Cunningham Ave. , dens Falls, N .11. ( LF
Section No. 27
owner James H. Haines Plot Wah-Ta-Wah
late June 6, 1938
abt_20 x 25 500 Superficial ft. @ 50ci = 4250.00 & 4125 .00=4375.00
,ocation North side of Algonquin Ave . Bd. east by Patterson; north by
Gibbs; west by Grass Path.
:orner Posts
.emarks
peed No. (and changes) 493
ayment Record Pd. 8/27/38
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Form No. 01
Record of Interments
1 1.- -1)Z,-\--\--\ A}► - 1 aLLI a,k c. r. 1 .ao•c,4, 5
2 Laura H. Ha nes 6/7/38 6 i{Gi>,// <,-. , ,:;/' F 9'/9. 31
3 James H. Haines 12/17/54 1 Aulaff H. Haines 4_ S_S Si+
4 8 4[c614-.ev n /.4-L , /0/e-offrke-i
? /r4-1ffie y,.�/ ,sr, b t.v, ,a,, /v - zF.,v,
10 David Wilder Atwood
c�. (1(.tD �rN /'T tWoc�
5. 1-<42e0 J Acau 1 T"W'
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ATWOOD (14!)
NAME Judith H. Atwood Age: 79
Lot Owner: James H. Haines
Lot# Wah Ta Wah 27-493 Grave#
Case: Concrete
Died: 1 .2 0.2 4 Interred: 1 .2 6.2 4
Funeral Home: Miller & Son FH INC.
Poughkeepsie, NY
CemeteryPine View