Hillard, Bette NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Bette L. Hillard Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 27,2018 94 _ War or Dates
1" Place of Death Hospital, Institution or
Z City, Town or Village Chester Street Address 116 Olmstedville Road,Pottersville
ci Manner of Death Undetermined Pending
X Natural Cause Accident Homicide Suicide
V' Circumstances Investigation
ui Medical Certifier Name Title
Kate Saur Jones MD
Address
HHHN,North Creek,NY 12853
Death Certificate Filed District Number Register Number
City, Town or Village Chester 5652
❑Burial Date Cemetery or Crematory
II Entombment May 30, 2018 Pine View Crematory
Address
❑x Cremation Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
1 Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00035
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
j , Remains are Shipped, If Other than Above
▪ Address
W
a
Permission is hereby granted to dispose of the human remains de r'bed above as indicated.
Date Issued 05-30-18 Registrar of Vital Statistics
(signatur
District Number S6SZ Place T/O Chester,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition %I I i a Place of Disposition ',.u,,.., e,„J}c,.,...
E (address)
cn
✓ (section) /lot mber) (grave number)
Q Name of Sexton or Person in Charge of Premises II,,, nu S6.-tCl
Z /�� (ple se print)
w Signature �,.� Title ( Em4141
(over)
DOH-1555 (02/2004)