Hodges, Bernadine L NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics -Vital Records Section
Name First Middle Last Sex
Bernardine L. Hodges female
Date of Death.::::............................................... .........................................
.......
Age If Veteran of U.S.Armed Forces,
8/30/89 84 War or Dates no
Place of Death Hospital, Institution or
City,Town or VillageCity of Glens Falls Street Address Glens Falls Hospital
k.� Cause of Deatli..... --- ......... ... ...... ......
' massive CVA due to cerebral vascular disease
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W Medical Certifier Name Title
Michael Crook MD
Address
::::...................................................... ................................................................................................................
62 Elm Street, Glens Falls, New York 12801
. :::Death Certificate::.: ..... ...................................... ............................
Filed
District Number Regist�umber
City,Town or Village City of Glens Falls
Date Cemetery or Crematory
❑Burial 9/1/1989 Pine View Crematorium
:................ :::::.:::.....:......;:.............:.:::.:.:::.:::::::::::::.:..:.....:.....:. ...:. ...........................:.......................................................
X❑Cremation
Address ... .......................
Town of Queensbury, New York
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Date Place Removed
❑ Removal and/or Held
and/or Hold : :::: ::::::;:. ......:::::::::::::::::::::::::::::::::::::::,::::::::::::::...........
Address
a Date Point of
❑Transportation by Shipment
CommonCarrier ...........................................................................................................................................................................................
Destination
..........................................:::::Date:::::...................................................... .......................................................................................................
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1-1 DisintermentCemetery Address
Date":,::..................................................... ......................
❑ Reinterment Cemetery Address
Permit Issued to : Registration Number
Name of Funeral Firm Regan and Denny Funeral Service, Inc. 01634
Add ress::::::................................
...........
.....................
..................................................................................................................................................................................
26 Quaker Road, Queensbury, New York 12804
f ................
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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/Idescribed above as Indicated.
» Date Issued Registrar of Vital Statistics �et ,f s ��•o-'7
(signature)
District Number Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
uZi' Date of Disposition 44ZZZPlace of Dispositiony� /moo✓ C :,•�EM�JrdiP%t��'l
(address)
>OC
W1 (section) (lot number) (grave number)
:
O
p Name of Sext or P rson in Charge of Premises
Z ( ase print)
W Signature Title
DOH-1555(9/86)p 1 of 2(formerly VS-61)