Bishop, Janice NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section - Burial - Transit Permit
mi Name First Middle Last Sex
Janice Bishop Female
Date of Death Age If Veteran of U.S. Armed Forces,
03/15/2014 War or Dates
1- Place of Death Town of Hospital, Institution or
Heritage Commons
tuZ City, Town or Village Street Address
Residential Healthcare
p Manner of Death Ma Natural Cause Accident D Homicide Suicide Undetermined Pending
0Circumstances Investigation
la Medical Certifier Name Title
Kathleen Hiesif MD
Address
102 Racetrack Rd. , Ticonderoga, NY 12883
Death Certificate Filed Town of District Number Register Number
City, Town or Village Ticonderoga 1 564 1 7
®Burial Date Cemetery or Crematory
March 18, 2014 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
9❑Removal and/or Held
and/or
Address
CO
Hold
C. Date Point of
Q Transportation Shipment
Et by Common Destination
Carrier
Q Disinterment Date Cemetery Address
iii! Q Reinterment Date Cemetery Address
Iiiiii Permit Issued to Registration Number
>> Name of Funeral Home Regan Denny Stafford Funeral Home 01 443
Address
53 Ouaker Road, Oueensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
';,' Address
tt
Permission is hereby granted to dispose of the human remain described above as indicated.
Date Issued 0 3/1 7/2 01 4 Registrar of Vital Statistics LJ' 77) . ?
(signature)
District Number 1 564 Place Town of Ticonderoga
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tLi Pine View Cemetery
of Disposition Place of Disposition
(address)
Ili
Ul
52 & 70 Mohawk 3
CC (section) (lot number) (grave number)
Name of Sext n or Person in Charge of Premise Connie L. Goedert
(please print)
la
Signature, e ---ec Title Superintendent
(over)
DOH-1555 (02/2004)