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Bills, John /005 NEW YORK STATE DEPARTMENT OF HEALTH •' -* Vital Records Section Burial - Transit Permit Name First Middle Last Sex John Jay Bills Male >G Date of Death Age If Veteran of U.S. Armed Forces, `;' December 17,2018 47 War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital e Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending tit Circumstances Investigation w Medical Certifier Name Title 0) Timothy E. Murphy Mr Address 1 52 Haveland Ave.,Glens Falls,NY 12801 Death Certificate Filed District Number Register Number . dl City, Town or Village Glens Falls 5601 ❑Burial Date Cemetery or Crematory December 18,2018 Pine View Crematory Entombment Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z Removal and/or Held and/or Address H Hold tO O ' Date Point of N Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number 1 Name of Funeral Home Alexander-Baker Funeral Home 00037 Address 11 3809 Main Street, Warrensburg,NY 12885 y:1 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above I Address w Permission is hereby granted to dispose of the human remains describedab e a led. v Date Issued / -/S/20/8-- Registrar of Vital Statistics /-i44-t/ ' (signature) District Number 5601 Place Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Zere 4..1- W Date of Disposition I Vitt/I� Place of Disposition �;��� �i�w M gc s w('^ 2 (address) W CO IX (section) 1(lot nu fiber) (grave number) a Name of Sexton or Person in Charge of Premises t"1.cL.,,e I p r./At tit Z ✓ (please print) w Signature (,✓l. Title (re i^- (over) DOH-1555 (02/2004)