Cross, Bernice r 'r
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Last Sex
Bernice Cross Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 29,2018 97 War or Dates n/a
yr Place of Death Ho ' -Institution or
Z City, Town or Village Queensbury,NY ddress 24 Pinecone Drive
Manner of Death C Natural Cause n Accident [1 Homicide Suicide riUndetermined 1 Pending
Circumstances Investigation
lJ;ttl; Medical Certifier Name Title
0 Dr Mihindu,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register Number
City, Town or Village Queensbury,NY 5657 it
0 Burial Date Cemetery or Crematory
Entombment March 30,2018 Pine View Crematory
Address
®Cremation Quaker Road,Queensbury,NY
Date Place Removed
Z t l Removal and/or Held
and/or Address
t- Hold
Cl)
O' Date Point of
y E Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
..,, Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human re ins d9scri a as 'ndicated.
Date Issued _act-c Pl j Registrar of Vital Statistics _Ut, t a'L
(signatu )
District Number 5657 Place Town of Queensb
ury,ury,NY 12804
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 3—,29.. I( Place of Disposition p;64, v.cad c{u tky
LU (address)
N
p0 (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises J tcr^-vy S 4 t,�;r�s
Z , (,� (please print)
LUSignature „�- � Title ci p...,014 0r
(over)
DOH-1555(02/2004)
r
Lot No. 41 }�
Address Harry & Bernice Cross SectitmNo'
Owner 17 Oak St., ''lens Falls, N.Y. Plot Oneida
)ate 3/27/80
35 Superficial ft. @ $125.00- ,ciry,:74,
LocationtheNorth byMatteson, East byArnold, South byRace, West by We b
Bounded on
Corner Posts
Remarks
Deed.No. (and changes) 1583
Payment Record Paid in full 3/2700
Form No. 01
Record of Interments
Ca •
I Bernice Cross 4/4/201R
.2
k-y C -23-rj 6
3 David M. Cross (11/11/80) 7
4 Melvin Cross 11 /29/2017 (Cremain) I 8 1
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CROSS
NAME A Age:g 97
Bernice Cross
Lot Owner:
Lot# Harry & Bernice Cross Grave#
1
Oneida #41 -B
Case:
Plastic Urn
Died: Interred:
Funeral?om 9/2 01 8 4/4/2 01 8
Cemetery: Regan,Denny,Staf ford
Pine View Cemetery