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Bishop, Boy t a ► 2 NEW YORK STATE DEPARTMENT OF HEALTH ` Vital Records Section Burial - Transit Permit Name First Middle Last Sex Boy Bishop Female Date of Death Age If Veteran of U.S. Armed Forces, May 7, 2017 L, ,t War or Dates i— Place of Death Hospital, Institution or W City, Town or Village Glens Falls Street Address Glens Falls Hospital WManner of Death 0 Natural Cause E Accident ❑ Homicide ❑ Suicide ❑ Undetermined El❑ Pending 0Circumstances Investigation W Medical Certifier Name Title J CI (nl 10 II(5wlid0E I�L'fSS ff0i.Ct-i?i Address '7e siti L1 s-f tEt f(LL,, p_v 17,301 . Death Certificate Filed District Number t. \ Regisf fiber City, Town or Village ❑Burial Date Cemetery or Crematory May 10, 2017 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held 0and/or Address F Hold CO Date Point of eL ❑Transportation Shipment COby Common Destination Carrier Date Cemetery Address El Disinterment Date Cemetery Address II Reinterment Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom I—' Remains are Shipped, If Other than Above 2 Address IX W' CrL Permission is hereby granted to dispose of the human remains descri 21301.aeas !.p ed. Date Issued 4S////20i7 Registrar of Vital Statistics � / �// (signature) District Number SGO/ Place Gl,Lw X/4 N) I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z iS M W Date of Disposition 05/10/2017 Place of Disposition Quaker Road Queensbury,NY 12804 i ,)7{!t.J,C)�s` -re_ ,71., ' W (address) Cr) GC (section) (lot num er) (grave number) 0 a Name of Sexton qr--Persanin Charge of Premises 3�" ` �' ��� C-t /' � (please print) W r 7 / Signature _' (1 -14 .- --, Title C- /4',-4 (over) DOH-1555 (02/2004)