Bigelow, Gene f 'NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Gene Francis Bigelow Male
Date of Death Age If Veteran of U.S. Armed Forces,
September 15, 2016 91 War or Dates
I- Place of Death Hospital, Institution or
Z City,ty, Town or Village Fort Edward Street Address 450 Lower Main St.
CI Manner of Death 0 Natural Cause ❑ Accident ❑ Homicide El Suicide ❑ Undetermined ❑ Pending
L1JU Circumstances Investigation
W Medical Certifier Name Title
C Christopher Hoy MD,
Address
Hudson Head Waters Queensbury, NY 12804
Death Certificate Filed District Number`� .-� Register Number
City, Town or Village 5 �� .. 4/g
,, 11 Burial Date Cemetery or Crematory
September 22, 2016 Pine View Cemetery
❑Entombment Address
0 Cremation Quaker Rd. Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
and/or Address
j_. Hold Pine View Cemetery
Date Point of
a ❑Transportation Shipment
(0 by Common Destination
0" Carrier
Date Cemetery Address
El Disinterment
Date Cemetery Address
❑ Reinterment
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
I— Remains are Shipped, If Other than Above
2 Address
IX
WQ.'"
Permission is her by g nted to dispose of the human - s described above a Indic ted.
Date Issue Registrar of Vital Statistic-. __e j p
(signature)
District NumbeE5-7Sc Place 7c. 71 ( i),,C/t'sCl/
I certify that the remains of the decedent identified a ove were disposed of in accordance with this permit on:
w Date of Disposition 09/22/2016 Place of Disposition Quaker Rd. Queensbury,NY 12804
2 (address)
W(.0Mohawk 43 2
IX (section) (lot number) (grave number)
O Connie L. Goedert
01 Name of Sext or Person in rge of Premises
Z,? (please print)
W Signatur Title Cemetery Superintendent
(over)
DOH-1555 (02/2004)