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Bogle, Phyllis, W
go y . NEW YORK STATE DEPARTMENT OF HEALTH `,,.. w Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Phyllis W.Bogle Female Date of Death Age If Veteran of U.S.Armed Forces, 09/22/2021 96 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc pManner of Death ©Natural Cause 0 Accident 0 Homicide 0 Suicide El Undetermined El Pending W Circumstances Investigation W Medical Certifier Name Title 0 John Quaresima MD Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 55 0 Burial Date Cemetery,Crematory or Facility Name 09/22/2021 Pine View Cremtorium Entombment Address 0 Cremation Queensbury.Hamlet,New York Donation Z ❑Removal Date Place Removed and/or and/or Held F- Hold Address to 0 Q. Date Point of 0❑Transportation Shipment S by Common Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom H 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 09/22/2021 Registrar of Vital Statistics Aimee L 9Kahoney(ECectronically Signed) (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: /J WDate of Disposition 11 Z 3 I/4 Place of Disposition 0�SQ L-i'�� 2 (address) W in (section) (lotnumb� (grave number) gName of Sexton or Person in Cha a of Premises 14- z '� (please print) W Signature (/J`/�/ Title `ACMi DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of i° delivered on , 20)/ A Pine View Cemetery ('Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# ` '