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Bonneau, Betty E. NEW YORKSTATE DEPARTMENT OF HEALTH t Permit Bureau of Vital Records Burial - Transit Name First Middle Last Sex Betty E Bonneau Female Date of Death Age If Veteran of U.S.Armed Forces, 12/11/2020 83 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Northumberland Town Street Address 6 Cherry Lane, Northumberland Town, New York 12831 W Undetermined Pending W Manner of Death © Natural Cause 0 Accident 0 Homicide 0 Suicide El Circumstances Investigation W Medical Certifier Name Title O Mark Quaresima MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Northumberland Town 4563 19 Burial Date Cemetery,Crematory or Facility Name 12/14/2020 Pine View Crematory ❑Entombment Address 0 Cremation Queensbury Town,New York ❑Donation Z ❑Removal Date Place Removed and/or and/or Held H Hold Address N t/3 ❑Transportation Date Point of 5 by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan&Denny Funeral Service 01444 Address 94 Saratoga Ave,S Glens Falls,New York 12804 Name of Funeral Firm Making Disposition or to Whom l— Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/14/2020 Registrar of Vital Statistics Denise D Murphy(ECectronically Signed) (signature) District Number 4563 Place Northumberland Town, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH Z of Disposition 12111if IZD Place of Disposition FiLAo- Date 111 2 (address) W NCr (section) A (lot number) (grave number) 8 Name of Sexton or Person in Charge of Pr mises �" p.1 y' — 5NA40 (pz se print) W Signature Title t i"h+1--04 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) i j ' 41 ?91 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#