Loading...
Bishop, Anita Agnes 1-1 Rr 6 _ NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Anita Agnes Bishop Female Date of Death Age If Veteran of U.S.Armed Forces, 07/06/2023 79 Years War or Dates F. Place of Death Hospital,Institution or pZ City,Town or Village Moreau Town Street Address 101 White Birch Estate,Moreau Town,New York 12828 Manner of Death El Natural Cause Accident 0 Homicide Suicide Undetermined ElPending W 0 Circumstances Investigation QW Medical Certifier Name Title David Cunningham MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 35 BurialEl Date Cemetery,Crematory or Facility Name 07/11/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York .11:Donation Z❑Removal Date Place Removed H and/or and/or Held N Hold Address 0 0. Date Point of N❑Transportation by Common Shipment " Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above a Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/10/2023 Registrar of Vital Statistics Brenda Yfutter(ECectroniralySigned) (signature) District Number 4562 Place Town Of Moreau I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition -]l I(1 23 Place of Disposition 4. 2 (address) W Cl) g (section/ d umber/ � /grave number/ Name of Sexton or Person in Char o� remises e l_. - 11- Z / (p e e print/ W Signature / Title (I 4'M�(06 DOH-1555(o7/18)p 1 of 2 v Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 t Pine View Cemetery Representing the funeral home named on,burial permit Official Funeral Directors Reg.or License# = `