Bills, Kathleen NEW YORK STATE DEPARTMENT OF HEALTH 0)0`"
Vital Records Section Burial - Transit Permit
i
Name First Middle Last Sex
Kathleen D. Bills Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 17,2015 60 War or Dates
'i;;: Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X Natural Cause Accident Homicide n Suicide Undetermined Pending
Circumstances Investigation
} Medical Certifier Name Title
AZ Noelle M. Stevens
Address
100 Broad St,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
�y
3 City, Town or Village Glens Falls (QG1 i t�0
❑Burial Date Cemetery or Crematory
March 19,2015 Pine View Crematory
Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
O Date Point of
N Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
«; Permit Issued to Registration Number
r tG: Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
:: Name of Funeral Firm Making Disposition or to Whom
I Remains are Shipped, If Other than Above
Address
it Permission is hereby granted to dispose of the human remains describ d above s i d' ated.
c
Date Issued Q3/?/2085—Registrar of Vital Statistics CI
(signature)
District Number J (a 0/ Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 3 --)u._t j Place of Disposition !fie L eK; (r-erng.44vr".'�e�
W (address)
Cl)
tY (section) �� (lot number) (grave number)
pName of Sexton or Person in Char e of Premises I i?lei U by Ni mi
LZ Tom_ �w�i'C (Please print)
Signature .1,4 "� fl,C�l.�.a Title C.rety LAor>„ 4-054-
(over)
DOH-1555 (02/2004)