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Bourdeau, Connie E
E.)/• _ . ,,, LIF NEW YORK STATE DEPARTMENT OF HEALTH Burial -Transit Permit Bureau of Vital Records Name First Middle Last Sex Connie E Bourdeau Female Date of Death Age If Veteran of U.S.Armed Forces, 10/28/2023 72 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death IZ Natural Cause ❑Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title 0 Asim Chaudry MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 502 ElBurial Date Cemetery,Crematory or Facility Name 10/31/2023 Pineview Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Z Removal Date Place Removed Q El and/or and/or Held ~ Hold Address N MT:Transportation Date Point of s by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment 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 t Remains are Shipped,If Other than Above 2 Address CC CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/31/2023 Registrar of Vital Statistics Megan Nolin(Electronically Signed) (signature/ District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 11 1 1173 Place of Disposition ?Z,)Et,' .! littatAireLii .ICJ - 2 (address) W NCr (section) 4 (lot number) (grave number) SName of Sexton or Person in Charge of P ises tl prntl� �h z W Signature 'Sc� Title 02,60 gi zie DOH-1555(07/18)p 1 of 2 1. 7 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View CemeteryR named on—burial permit Official Funeral Directors Reg.or License#