Neddo, Bonnie NEW YORK STATE DEPARTMENT'OF HLIALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Bonnie L_ Nerdo Female
Date of Death Age If Veteran of U.S. Armed Forces,
Dec. 02, 2017 57 yrg_ War or Dates no
I. Place of Death Hospital, Institution or
Z City, Town or Village Fort Ann Street Address 1 69 West Starbuck Rd.
Manner of Death Natural Cause ❑Accident ❑Homicide ❑Suicide LiUndetermined ❑Pending
ta Circumstances Investigation
tu Medical Certifier Name Title
CI David Foote MD.
Address
340A Main St. , Hudson Falls, NY. 12839
Death Certificate Filed District Number Register Number
City, Town or Village Fort Ann 5754 i3
❑Burial Date Cemetery or Crematory
Dec. 04, 2017 PineView Crematorium
['Entombment Address
tliCremation Queens bury, NY. 1 2 8 0 4
Date Place Removed
Z In Removal and/or Held
and/or Address
H Hold
0 Date Point of
filri❑Transportation Shipment __ _
Et by Common Destination
Carrier _ _
Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Mason Funeral Home R01 1 1ration Number
Name of Funeral Home
Address
18 George St. , P.O. Box 277, Fort Ann, NY. 12827
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
Ili
l` Permission is hereby granted to dispose of the human rejn ns described above as'nd- d.
Date Issued 1 2/04/1 7 Registrar of Vital Statistics {f /,�. � ® -
7/� signature) ,
v
District Number 5754 Place 9 / /oZ T.c?7
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
ILI Date of Disposition 1,Z-1±11 Place of Disposition p,y,p U ;P..pt) 1 z04 c7
(address)
W
U)
cc (section) ay number) (grave number)
• Name of Sexton o rs n in Charge of Premises i-G.✓7 yy7 4�c.4r
(please print)
La
Signature Title C--,ez-3444-'i-
(over)
DOH-1555 (02/2004)