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Bilodeau, Mark S
)31 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Mark S Bilodeau Male Date of Death Age If Veteran of U.S.Armed Forces, 09/02/2021 69 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address 13 Wait Street,Glens Falls,New York 12801 p Manner of Death ©Natural Cause D Accident ❑Homicide 0 Suicide ❑Undetermined ❑Pending W Circumstances Investigation U W Medical Certifier Name Title Sean Campanie NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Glens Fails 5601 374 Burial Date Cemetery,Crematory or Facility Name 09/03/2021 Pineview Crematory Entombment Address lCremation Queensbury Town,New York ElDonation ❑Removal Date Place Removed and/or and/or Held H N Hold Address O tl Date Point of Cl) LiTransportation Shipment by Common Carrier Destination Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped,If Other than Above a Address Q W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/03/2021 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (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: Z • Date of Disposition 'y 078Zi Place of Disposition Pi ,„"e t 4vl' !LI) (address) W CC N (secant)) (lot number) (grave number) gName of Sexton or Person in Cha of Premise Li Z t (p/ease print) W Signature Title UA.erg,4 — DOH-1555(07/18)p 1 of 2 ()I ,;:', 1 5 Public Health Law Sec. 4145(2b) Receipt 0 ' ° Human remains of delivered on ' , 20 :' • Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# i _i—'