Beaudoin, Gilles O. 4r10�
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Gilles 0.Beaudoin Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/28/2020 83 Years War or Dates
F Place of Death Hospital,Institution or
ZCity,Town or Village Glens Falls Street Address Glens Falls Hospital
Mannerof Death Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
V
W Medical Certifier Name Title
Shahid Ahmed MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 49
❑Burial Date Cemetery,Crematory or Facility Name
01/31/2020 Pine View Crematory
Entombment Address
X❑Cremation Queensbury,New York
Donation
Z Date Place Removed
❑Removal
and/or and/or Held
H Hold Address
W
O
IL Date Point of
N ❑Transportation Shipment
Q by Common
Carrier Destination
Disinterment Date Cemetery Address
Reinterment [Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition orto Whom
IH Remains are Shipped,If Otherthan Above
S Address
IX
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/29/2020 Registrar of Vital Statistics RD6ert,? rewC-&&(ElectronkaYSomd)
(signature/
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I
Z Date of Disposition c�—�'201,E Place of Disposition i �` J_ 4.4'3 1
W (address)
2
W
Q (section) (lot num r) (grave number)
Name of Sexton or Person in Cha of Premise Y 10
(please print)
W v Signature . �/' d� Title
DOH-1555(o7/M)p 1 of 2
Public Health Law Sec. 4145(2b) 0 3 0 2 j
r
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#