Bernard, Aleda Ali 61
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section , urial - Transit Permit
Name First Middle Ldst Sex
Aleda Bernard Female
Date of Death Age If Veteran of U.S.Armed Forces,
February 21, 2006 83 War or Dates
2 Place of Death Hospital, Institution or
W City,Town,or Village Glens Falls Street Address Glens Falls Hospital
G Manner of Death E Natural Cause 0 Accident ❑Homicide 0Suicide ❑Undetermined ❑ Pending
Circumstances Investigation
0 Medical Certifier Name Title
Dr. Nawed Siddiqui, M.D. Dr.
Address
100 Park Street, Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5 6 0 1
❑Burial Date Cemetery or Crematory
February 23, 2006 Pine View Crematory
❑Entombment Address
2 ❑% Cremation Quaker Road Queensbury, NY 12804
Date Place Removed
0 0 Removal and/or Held
m. and/or Address
Hold
11) Date Point of
0 ❑Transportation Shipment
a by Common Destination
Carrier
Date Cemetery Address
0 ❑Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home 01142
Address
82 Broadway, Fort Edward, New York 12828
~ Name of Funeral Firm Making Disposition or to Whom
cece Remains are Shipped, If Other than Above
W Address
Permission is hereby granted to dispose of the human remains described abov s indicated.
Date Issued '2) 2 Z/Q-CRegistrar of Vital Statistics XS✓L�
(signature)
District Number 5 6 C j Place Glens Falls,New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition 02/23/2006 Place of Disposition Pine View Crematory
W (address)
Q (section) (lot number) (grave number)
ZName of Sexton or Person in Charge of Premises /4 i e R I-) 7
(please print)
Signature eeivt Title C g �/k 'I'd
/� (over)
DOH-1555 (02/2004)