Bonneau Sr. Leo J. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Leo J.Bonneau Sr Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/27/2020 193 Years War or Dates 44-46
F Place of Death Hospital,Institution or
Uj Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
aManner of Death �Natural Cause �Accident �Homicide �Suicide ❑Undetermined 0 Pending
Circumstances Investigation
Medical Certifier Name Title
Stephen Perazzelli MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 144
Burial Date Cemetery,Crematory or Facility Name
03/30/2020 Pine View Crematory
Entombment Address
LED Cremation Queensbury,New York
Donation
Z❑Removal Date Place Removed
and/or and/or Held
Hold Address
t/1 Transportation Date Point of
CTj by Common Shipment
Carrier Destination
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan&Denny Funeral Service 01444
Address
94 Saratoga Ave,S Glens Falls,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
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IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/30/2020 Registrar of Vital Statistics WpAert/gadrervCirrtzr(EYectronicad Srgnerl�
(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:
Date of Disposition 3 Zb Place of Disposition ,lu
lu (address)
W
N
cc (section) (lot umber) \ (grave number)
J\
Name of Sexton or Person in Charge of Pre ises c° Ml�
IT
Z (plea print/
W Signature4 Title rr
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 013487
Receipt
Human remains of i = . delivered on ; ' , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
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