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Wood, Beverly Joan
tOF NEWYORKSTATEDEPARTMENTOFHEALTH Transit Permit Bureau of Vital Records Burial Name First Middle Last Sex Beverly Joan Wood Female Date of Death Age If Veteran of U.S.Armed Forces, 03/14/2024 80 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital LU p Manner of Death IZI Natural Cause Accident 1:1Homicide El Suicide ❑Undetermined Pending W Circumstances Investigation C.) Medical Certifier Name Title CI Marvin Davidowitz 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 152 Burial Date Cemetery,Crematory or Facility Name i.... 03/18/2024 Pine View Crematory _Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held F— Hold Address N 0 C. Date Point of Cl)EITransportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address El Reinterment Date Cemetery Address 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 H Remains are Shipped,If Other than Above 5 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/18/2024 Registrar of Vital Statistics Megan No(in(ECectronicaC(ySigned) (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: I— Z Date of Disposition 3118 1Zi Place of Disposition I vF✓,..> Cit'A4 4 rt&I_. 2 (address) W V) ft (section) l (lot numb (grave number) O• Name of Sexton or Person in Charge of Premise `/`;"ML in !(please print) / lJJ � // � (COO Signature C,�� Title I DOH-1555(07/18)pi of 2 i 1 r. 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#