Beaudoin, Jill Marie NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Jill Marie Beaudoin Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/21/2020 56 Years War or Dates
F Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death a Natural Cause El Accident Homicide 0 Suicide El Undetermined EI Pending
IllCircumstances Investigation
C.)
W Medical Certifier Name Title
0 Michael Miles MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 521
❑Burial Date Cemetery,Crematory or Facility Name
11/23/2020 Pine View Crematory
❑Entombment Address
EICremation Queensbury Town,New York
ElDonation
Date Place Removed
2 ❑Removal and/or and/or Held
H
0Hold Address
0
iII. Date Point of
U) 11 Transportation Shipment
G by Common
Carrier Destination
Date Cemetery Address
ElDisinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
2 Address
Cr
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/23/2020 Registrar of Vital Statistics Wp6ertf7narraw Curtis(/'ctronicalySigned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:P'L
/L—
WDate of Disposition I))24 170 Place of Disposition
2 (address)
W
NCC (section) (lot number (grave number)
Name of Sexton or Person in Charge o remises �i r..�1Vl °"�{
(please print) /
W rik
Signature 2-as-
Title 6 F/h�""�
g
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 014 2 2 0
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#