Glendening, Bonnie 6.
NEW YORK STATE DEPARTMENT OF HEALTH 1 - ._'�
Vital Records Section Burial - Tr nsi# Permit
Name First Middle Last Sex
{/1 Bonnie Lee Glendening Female
Date of Death Age If Veteran of U.S. Armed Forces,
October 8,2014 69 War or Dates _
f Place of Death Hospital, Institution or
- City, Town or Village Queensbury Street Address 395 Ridge Road
Manner of Death n Natural Cause Accident E Homicide E Suicide 0 Undetermined -Pending
` ` Circumstances Investigation
3<. Medical Certifier Name Title
7 Dr Hogan
VC Address
�'irl
Queensbury,NY
'�"` Death Certificate Filed{" District Number Register Number
- City, Town or Village Queensbury,NY 5657
❑Burial Date Cemetery or Crematory
❑Entombment October 14,2014 Pine View Crematorium
Address
®Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
z Removal and/or Held
and/or Address
F' Hold
U)
0 Date Point of
O.
L j Transportation Shipment
p by Common Destination
Carrier
EI
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
ft Permit Issued to ` Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
4 Address
r<1
407 Bay Road,Queensbury,NY 12804
f Name of Funeral Firm Making Disposition or to Whom
' Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described bq�ve as indicated.
fr
:f
Date Issued I DI t��ct�f Registrar of Vital Statistics - /2.L,..-
(signature)
X District Number 5657 Place Queensbury,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
usDate of Disposition ioftlii Place of Disposition u,;.,,y C 4"---
W (address)
N
pCe (section) ,lot number) (grave number)
Name of Sexton or Person in Charge of Premises , r,�{ 1 4wti-
Z (please print)
W Signature - Title llit4
(over)
DOH-1555(02/2004)