Burke, Judith I fit 1I
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
JUDITH M. BURKE Female
Date of Death Age If Veteran of U.S. Armed Forces,
December 7,2017 75 War or Dates n/a
1,.. Place of Death Hospital, Institution or
Z City, Town or Village Queensbury,NY Street Address 7 Bonner Drive
pManner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
W — — Circumstances Investigation
to Medical Certifier Name Title
Ci Timothy Murphy,Coroner
Address
Glens Falls,NY
Death Certificate Filed District Number Register Number
City, Town or Village Queensbury,NY 5657 t ca,t-
❑Burial Date Cemetery or Crematory
December 11,2017 Pine View Crematory
❑Entombment Address
®Cremation Queensbury,NY
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
f- Remains are Shipped, If Other than Above
a Address
et
W
C!. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued t .•1 t -d-0 ll Registrar of Vital Statistics _(_ . '`k& c.;.;,�,_.-°
(signature)
District Number 5657 Place Town of Queensbury,NY 12804
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
iti Date of Disposition illIn Place of Disposition f'..it...,/ ( I''--.
2 (address)
COLIJI
0 (section) /�l (lot number) (� (grave number)
pName of Sexton or Person in Charge of Pre ises G 4,,, t,- J a--10-
Z lease print)
W ���111111 /
Signature ' 1 Title I t L
(over)
DOH-1555(02/2004)