Loading...
Bombard, Ellen Marie ,;- .It (13 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Ellen Marie Bombard Female Date of Death Age If Veteran of U.S.Armed Forces, 02/22/2022 67 Years War or Dates H Place of Death Hospital,Institution or 'Z City,Town or Village Moreau Town Street Address 99 Mountain Road,Moreau Town,New York 12831 pManner of Death ©Natural Cause Accident Homicide ❑Suicide 0 Undetermined ❑Pending U Circumstances Investigation li;l Medical Certifier Name Title D Mary Stein NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Moreau 4562 11 ❑Burial Date Cemetery,Crematory or Facility Name 02/24/2022 Pine View Crematory ▪Entombment Address 0 Cremation Queensbury Town,New York ▪Donation Z ❑Removal Date Place Removed © and/or and/or Held I Hold Address N 0 11 Date Point of Cl) ❑Transportation Shipment a by Common Carrier Destination Date Cemetery Address ❑Disinterment 0 Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above a Address cc W n, Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/23/2022 Registrar of Vital Statistics Geeann Mc cabe(ECectronicaCCy Signed) (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: F- 7 Z Date of Disposition 2..t I,_-2azi-Place of Disposition i /)if U fit.) Lce-en c�, W (address) W C (section) (lot number) (grave number) CC g Name of Sexton or Per in Charge of Premises At./ie. '* 4"'n' P (please print) Z W Signature Title G/�,y�,/1 eyes DOH-1555(07/1 p 1 of 2 l, P . , Public Health Law Sec. 4145(2b) Receipt 7 1 Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#