Bisaillon-Foote, Bonnie —.. ft z7Z._
NEW YORK STATE DEPARTMENT OF HEALTH lik
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Bonnie M.Bisaillon-Foote * ` Female
Date of Death Age If Veteran of U.S. Armed Forces,
04/01/2018 67 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls , Street Address Glens Falls Hospital
Manner of Death Dri Natural Cause 0 Accident 0 Homicide 11 Suicide ri Undetermined ri Pending
Circumstances Investigation
Medical Certifier Name Title
Noelle Stevens MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 166
❑Burial Date Cemetery or Crematory
04/03/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/03/2018 Registrar of Vital Statistics g6ertA Curtis(ECectronica1TySigned)
(signature)
4-1 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 4/11if Place of Disposition fmd-- � ,_
(address)
(section) ,9 (lot number) (grave number)
Name of Sexton or Person in Charge of Premises ( ". c"''
(please print)
Signature (/,�'(/j Title 1 for R'" '
(over)
DOH-1555(02/2004)