Bisnett, Arlene NEW YORK STATE DEPARTMENT OF HEALTH * ` /I 3 72
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Arlene Frances Bisnett Female
Date of Death Age If Veteran of U.S. Armed Forces,
April 30, 2015 89 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address 24 Second Street
Manner of Death I I Natural Cause ❑ Accident ❑ Homicide ❑ Suicide El Undetermined ❑ Pending
Circumstances Investigation
Medical Certifier Name Title
Agee!A. Gillani, M.D. Dr.
Address
102 Park Street Glens Falls, NY 12801
Death Certificate Filed District Number n 1 Registerr3ticr \
City, Town or Village Glens Falls
❑Burial Date Cemetery or Crematory
May 4, 2015 Pine View Crematory
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
Hold
Date Point of
,'El TransportationShipment
by Common Destination
Carrier
❑ Disinterment Date Cemetery Address
Date Cemetery Address
El Reinterment
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078
Address
136 Main Street, South Glens Falls NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
uj
a.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 45 )G z-1 //5 Registrar of Vital Statistics (.J CsA -y—A.
(signature,
District Number 5 601 Place 6 (CMS U,$) 17
`` I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i , Date of Disposition 05/04/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
F
(section) i(lot number) (grave number)
Of Name of Sexton or Person in Charge of Premises L 4,r` --sew
(pl ase print)
Signature Title rofrilitir4,,
(over)
DOH-1555 (02/2004)