Stockwell, Bonnie .11
NEW YORK STATE DEPARTMENT OF HEALTH �(o�
Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Bonnie Jo Stockwell Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 22, 2013 57 War or Dates
i"— Place of Death Hospital, Institution or
W City, Town or Village Glens Falls Street Address Glens Falls Hospital
11W' ini
Manner of Death rcri Natural Cause 1-7Accident ElHomicide 0 Suicide n Undetermined ri Pending
Circumstances Investigation
W Medical Certifier Name Title
t:1'' Darci Gaioth-Grubbs, Dr.
Address
102 Park Street Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village 5601 1 l 5
❑Burial Date Cemetery or Crematory
March 25, 2013 Pine View Cemetery
❑Entombment Address
®Cremation Quaker Rd. Queensbury,NY 12804
Date Place Removed
z lEl l Removal and/or Held
I and/or Address
p', Hold
GO Date Point of
d n Transportation Shipment
CD by Common Destination
CI Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
F-i Remains are Shipped, If Other than Above
2 Address
W,
° Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 3 ( as / ! .g Registrar of Vital Statistics c& !�-1.`Q uv_ ,,,.e
(signature)
District Number 5601 Place b 6,NiNs Rk \,k S y
I
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition ?,-W Place of Disposition
W P 13ft ,jU1w in-it1 ,-
W! (address)
C (section) l(lot number) , yL (grave number)
d Name of Sexton or Person in Charge of Premises l„►�i�
(pi se print)
W Signature Title C L fl1P OL
(over)
DOH-1555 (02/2004)