Bonet, William t- • ,,
# 533
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
;r Name First Middle Last Sex
irj: William Bonet Male
fDate of Death Age If Veteran of U.S. Armed Forces,
.f: July 27,2016 59 War or Dates
r Place of Death
i Hospital, Institution or
Citiiiy, Town or Village Moreau Street Address 1331 State Rt. 9
Manner of Death Natural Cause I XI Accident (—Homicide Suicide Undetermined Pending
Circumstances Investigation
Alk Medical Certifier Name Title
Scott Miller,PA Address
r 100 Broad Street,Glens Falls,NY
'rr� Death Certificate Filed District �VL \umber Register Number
;r. City, Town or Village Moreau � 4.
El Burial Date Cemetery or Crematory
July 28, 2016 Pine View Crematory
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZZ Removal and/or Held
and/or Address
F Hold
Cl)
O Date Point of
WTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
r Permit Issued to Registration Number
r Name of Funeral Home Regan& Denny Funeral Home 01444
,,f Address
,f.
rr 94 Saratoga Avenue, South Glens Falls,NY 12803
:we::' Name of Funeral Firm Making Disposition or to Whom
•
Remains are Shipped, If Other than Above
Address
I
Permission is hereby granted to dispose of the human remains
desc 'bed above as indicated.
'irj Date Issued ?/2ot:' Registrar of Vital Statistics /az. c,
' 1
' ;1 signature)
;: District Number g_ Place 3 J3 !c/2 1.I CJ a 8
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z W3 Date of Disposition 1/Ta J(6 ine O r'
Place of Disposition A. avnalp,4_,
Ili
(address)
W
O (section) /�/ (lot number) t (grave number)
pName of Sexton or Person in Charge of Premises Lets Jtlr*
Z (Please print)
W
Signature . 41 Title /eeitli1- L
(over)
DOH-1555(02/2004)