Bocchi, Bonnie NEW YORK STATE DEPARTMENT OF HEALTHt % 83
Vital Records Section Burial - Transit Permit
` Name First Middle Last Sex
sR
k- Bonnie Jean Bocchi Female
Sa Date of Death Age If Veteran of U.S. Armed Forces,
Janua 19, 2018 68 War or Dates
^'' Place ath Hospital, Institution or
City, own o Village Street Address 1105 Co Rte 31
Manner of Death X❑Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
. Medical Certifier Name Title
0 John Stoutenberg MD, M.D. Dr.
Address
TA 102 Park St. Glens Falls, NY 12801
1 Death Certificate Filed District Number Register Number
;A: City, Town or Village
❑Burial Date Cemetery or Crematory
�_ January 23, 2018 Pine View Crematorium
❑Entombment Address
iNi, ®Cremation Quaker Road Queensbury,NY 12804
411 Date Place Removed
❑ Removal and/or Held
and/or Address
Hold
'l Date Point of
, ❑Transportation Shipment
by Common Destination
Carrier
ElDisinterment Date Cemetery Address
Date Cemetery Address
_El Reintermen70.0
t
im Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
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 re ins de rib above indi ated.
,# Date Issued /-33 /( Registrar of Vital Statistics j t�
2., (signature)
District Number6-76 0 Place tie (�"0
I certify that the remains of the decedent identified above were disposed 19f in accordance with this permit on:
-z)- pihtZt, C/ ��C+i�
Date of Disposition 0 1/2812 0 1 8 Place of Disposition Quaker Road Queensbury,NY 12804
p p ry.
(address)
(section) N (lot number) (grave number)
Name of Sexton or P o i arge of Premises u< <.2,..r4 6 z�.e."4 —
(please pant)
Sitsognature .12/(- Title C`,--e-k'z�- '---
(over)
DOH-1555 (02/2004)