Bilodeau, Leona K NEWYORK STATE DEPARTMENTOF HEALTH Burial - Transit Permit
Bureau of Biostatistics-Vital Records Section
Name First Middle Last Sex
>'>> Leona K. Bilodeau
Female.....
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Date of Death € Age ff Veteran of U.S.Armed Forces,
Aprl...:4'.::.....1.98.9.. 64.................... War or Dates.......Np....................................... .............................................
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Place of Death Hospital, Institution or
_.City,Town orVillage Lake Placid Street Address 10 Placid Hei, hts
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Cause of Death
::..........Acute carbon,,,monq.x d :pa: :so:Hang:.::d :ty..::::g:e. lera:t.c�.r:::::e.xk�
Medical Certifier Name Title
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Address
W illsboro ,.:::::N: ::::Y..:::::.::::.::::1:2...9...8.::::::..::::::::::::::::..::..::-::..:::.....:...................................................................
::::::«:::::::.:: .......::::::::::::::::::::::::::... ........................
Death Certificate Filed District Number Register Number
City,Town or Village Lake Placid 1560 17
Date Cemetery or Crematory
❑Burial A..r:il.::..21 .....1. .8......................>...P.ine...V.z.ew....Cx.e.ma.ta.r .........................................................................::..:..:....... ...:.p ..:::.. .......,......:....9..:..9.......................................................................................... .........................................................................
nx Cremation Address
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Date Place Removed
O ❑ Removal and/or Held
and/or Hold ............::........:::::::::::::::::::::::::::::::::::::::::::::::::;>::::::::::::::::::::::::::::::::._::::::..:::::::::::......:: ......:::::::::::......::::::......:::._::......:::..................:::::::
Address
1�> Date Point of
w ❑Transportation by Shipment
Common Carrier ...........................................................................................................................................................................................
_..
Destination
.......... : : : . ..........................................................Date Cemetery Address
Disinterment .........
1-1 .................. .::::::at::::::....................................................... :::::......: ::::::.....................................................................................................
Renterment Date CemeteryAddress
Permit Issued to Registration Number
Name of Funeral Firm M. B . Clark, Inc . ... . 004-.22::::::.:::::::::::::::::::.:::::::::::::
Address ::::::::::::.�::::::::::,:::::::::::::::::::::::::::::::.�::::::.:::...::.:. -
2.7....Saran ac...Ave.a..,....Lake..Plac. .d. ....1V.......X................................. ..........................:::.::::::::::::::::.:::::::::.
Name of Funeral Firm Making Disposition or to Whom
"i Remains are Shipped, If Other than Above
...................................................
Address
U.
Permission Is hereby granted to dispose of the human remains described above as indicated.
" Date Issued 4Z2 0Z8 qr Registrar of Vital Statistics " la_
(signature)
District Number 1560 Place Lake Placid, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w' Date of Disposition "cZ�" Place of Disposition ��/✓.���•�' k/ �i�/�f�s9 T/t�/!�/�
(address)
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W
fY (section) (lot number) (grave number)
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p Name of Sexton orPerson in harge of Pre ises
Z (please print)
U.. Signature Title
DOH-1555(9/86)p 1 of 2(formerly VS-61)