Bohannon, Victoria Lee NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records:
Name First Middle Last Sex
Victoria Lee Bohannon Female
Date of Death - Age If Veteran of U.S.Armed Forces,
12/19/2021 70 Years War or Dates
F— Place of Death Hospital,Institution or
Z City,Town or Village - _ Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
Manner of Death _0 Natural Cause 0 Accident 0 Homicide 0-Suicide ❑Undetermined Pending
VCircumstances Investigation
G Medical Certifier Name Title
Courtney Diamond NP
Address
170 Warren St,Glens Falls,New York 12801 -
. - Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 625
Burial Date Cemetery,Crematory or Facility Name
12/27/2021 Pine View Crematory
❑Entombment Address
ECremation Queensbury,New York
Donation
Removal Date Place Removed
and/or and/or Held
HN Hold Address
0
O. Date Point of
ci) ❑Transportation
p 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 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
2 Address
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/27/2021 Registrar of Vital Statistics R96ert,?ndrew Curtis(Ekctronicaf SOnerl)
(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:
I- —�-�
Z Date of Disposition ��?_ a -
� Place of Disposition ! t,,of) L)j 670104 r�1
(address)
_J
W
N
(section) (1 numb (grave number)
g Name of Sexton or Person in Charge o remis �h/e/V
�i� ion
please print)
W Signature Title
DOH 1555(07/18)p i of 2
1 ,
Public Health Law Sec. 4145(2b)
Receipt
1
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#