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Battease, Bernice NEW YORK STATE DEPARTMENT OF HEALTH r - `> Vital Records Section Burial - Transit rermit Name First Middle Last Sex Bernice Battease Female Date of Death Age If Veteran of U.S.Armed Forces, September 14, 2015 77 War or Dates 2 Place of Death Hospital, Institution or W City,Town,or Village Glens Falls Street Address Glens Falls Hospital Manner of Death ©Natural Cause 0 Accident El Homicide 0 Suicide 0 Undetermined 0 Pending W Circumstances Investigation a Medical Certifier Name Tdle W Dr. Paul Byron, M.D. Dr. a Address 200 Smith Drive, Corinth, NY 12822 Death Certificate Filed District Number / Register Number City,Town or Village Glens Falls S(('6j VS-1 ❑Burial Date Cemetery or Crematory September 17, 2015 Pineview Crematorium ❑Entombment Address 0 Cremation Queensbury, NY 12804- Date Place Removed aEl Removal and/or Held - and/or Address I' Hold 14 Date Point of 0 0 Transportation Shipment D. by Common Destination Carrier Date Cemetery Address Q0 Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Jillson Funeral Home, Inc. 00885 Address 46 Williams Street, Whitehall, New York 12887 ~ Name of Funeral Firm Making Disposition or to Whom 2 Remains are Shipped, If Other than Above X W Address O. Permission is hereby granted to dispose of the human remains described above as indicated. , Date Issued O ,161 IS` Registrar of Vital Statistics LA) (signature) District Number 560 / Place Glens Falls,New York F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z w Date of Disposition 09/17/2015 Place of Disposition Pineview Crematorium 2 (address) W 0 0 (section) t number) (grave number) 0• Name of Sexton or Person in Charge of Pre ises (At So*a Z (ple se print) W j Signature t, Title agm4TAL (over) DOH-1555 (02/2004)