Bidwell, Eugene NEW YORK STATE DEPARTMENT OF HEALTH -' Ai ' '
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Eugene Elbert Bidwell Male
Date of Death Age If Veteran of U.S.Armed Forces,
December 5, 2011 93 War or Dates World War II
Place of Death Hospital, Institution or
ui City, Town or Village Argyle Street Address PLEASANT VALLEY NURSING FAC.
Manner of Death 0 Natural Cause D Accident El Homicide El Suicide ElUndetermined El Pending
Circumstances Investigation
Medical Certifier Name Title
Dr. Edit Masaba,
Address
McClellan Health System Salem, NY 12865
Death Certificate Filed District Number Register Number
City, Town or Village
❑Burial Date Cemetery or Crematory
December 6, 2011 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
Removal
O and/or and/or Held
Address
M Hold
O Date Point of
o. Transportation Shipment
0 by Common Destination
a Carrier
, ElDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
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
sxAddress
11.1
IL Permission is hereby granted to dispose of the human re ins described above s indicated.
' Date Issued /�- �/ /, Registrar of Vital Statistics �a r
�'Y (signature)
District Number `f 52 Place t. Ob CV yle-C—_—
I certify that the remains of the decedent identified above were disposed of in accordance' with this permit on:
W Date of Disposition DV_i1 Z011 Place of Disposition rmt)anJ ( fr'sveisu _
W (address)
CO
C (section) (lot number),-- (grave number)
0. Name of Sexton or Person in Ch rge of Premises (Lc,Avrlit
z, (please print)
g
Si nature l/"t
1�f� Title C1 we It
(over)
DOH-1555 (02/2004)