Baudoux III, Zen ,-",--
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Zen Baudoux III Male
Date of Death Age If Veteran of U.S. Armed Forces,
May 27, 2018 74 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Corinth Street Address 414 Oak Street
Manner of Deathrn
1
E.J Natural Cause ❑ Accident ❑ Homicide ❑ Suicide 1-1 Undetermined ❑ Pending
o Circumstances Investigation
W Medical Certifier Name Title
CI David Tucker Slingerland, Dr.
Address
9 Carey Road Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Corinth
❑Burial Date Cemetery or Crematory
May 29, 2018 Pine View Crematory
0 Entombment Address
, y®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
7 ❑ Removal and/or Held
and/or Address
p Hold
a Date Point of
❑Transportation Shipment
by Common Destination
O Carrier
Date Cemetery Address
III Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079
Address
82 Broadway, Fort Edward NY 12828
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
Address
LU
II' Permission is h reb granted to dispose of the human -mains d crib o ' ated.
Date Issued Registrar of Vital Statistics —/ .a/14-
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ignature)
District Number Place
l
dispo
sed of in accordance with this permit on:
W Date of Disposition 05/29/2018 Place of Disposition Quaker Road Queensbury,NY 12804
2 (address)
(section) (lot nu er) (grave number)
2 Name of Sexton or Person in Charge of Premises 1��.) 3`osit
/�
(please print)
W Signature & ,,r Title iiDevt tqrt,
T
(over)
DOH-1555 (02/2004)