Bureau, Rene 7
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Rene D. Bureau Male
Date of Death Age If Veteran of U.S. Armed Forces,
October 2,2015 88 War or Dates
• Place of Death Hospital, Institution or
,Z: City, Town or Village Glens Falls Street Address The Pines At Glens Falls
QManner of Death [XI Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
tu Medical Certifier Name Title
Gwendalyn Morris-Dickinson
Address
100 Broad Street,Glens Falls,NY 12801
Death Certificate Filed District Number Registetppum r
City, Town or Village 5601 D)
❑Burial Date Cemetery or Crematory
October 5, 2015 Pine View Crematory
0 Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
52 and/or Address
t Hold
CO
O Date Point of
u) Transportation Shipment
p by Common Destination
Carrier
Disinterment Date. Cemetery Address
n Renterment
Date Cemetery Address
Permit Issued to Registration Number
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
!-- Remains are Shipped, If Other than Above
Address
Ee.
Permission is hereb granted to dispose of the human remains described above as indicated.
Date Issued 76 S Registrar of Vital Statistics LA) C .2 W
(signatu
District Number 5601 Place Glens Falls / /CY /02M
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition a.olc Place of Disposition p;he,V;eiv
2 (address)
N
(section) if (lot numb) (grave number)
p• Name of Sexton or Person in Ch rge of Premises ` r:� -- ,;m.tt
'LI Z (phase print)
Signature Title 1 %Q
(over)
DOH-1555 (02/2004)