Duger, Bette Lou NEW YORKSTATE DEPARTMENT OF HEALTH , aI
Bureau of Vital Records Burial - Transit Per mimi
t
Name First Middle Last Sex
Bette Lou Duger Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/09/2020 82 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Moreau Town Street Address 24 Jacobie Road, Moreau Town,New York 12803
'p Manner of Death El Natural Cause I=1 Accident ❑Homicide El Suicide ElUndetermined 1=1 Pending
Circumstances Investigation
WMedical Certifier Name Title
G Christopher Mason DO
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Moreau 4562 48
Burial Date Cemetery,Crematory or Facility Name
11/12/2020 Pine View Crematory
ElEntombment Address
EiCremation Queensbury Town,New York
ElDonation
0 Removal Date Place Removed
and/or and/or Held
N Hold Address
0
a- Date Point of
W U Transportation
p by Common Shipment
Carrier Destination
El
Disinterment
Date Cemetery Address
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
F— Remains are Shipped,If Other than Above
I Address
CC
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/12/2020 Registrar of Vital Statistics LeeannMc cage(E/ctronica1514,ned)
(signature)
District Number 4562 Place Moreau, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition If 112 /70 Place of Disposition
2 (address)
W
N (section) '(lot number) (grave number)
Name of Sexton or Person in Charge of remises r � iv%&di
z (pie a print) n '
W Signature Title two?
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0 .141 90
Receipt
Human remains of delivered on , 20—
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#