Catone, June NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
June M. Catone Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 18, 2011 85 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address The Pines
t ,:
Manner of Death Fri Natural Cause ❑ Accident 0 Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
r• Medical Certifier Name Title
' Jennifer Stratton, M.D. Dr.
A
Address
170 Warren Street Glens Falls, NY 12801
Death Certificate Filed District Number 5 Register Number
City, Town or Village ' 2 Z g'
kJm Burial Date Cemetery or Crematory
May 21, 2011
❑Entombment Pine View Cemetery
Address
Al❑Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z❑ Removal and/or Held
and/or Address
Hold
•
Date Point of
' ❑Transportation Shipment
by Common Destination
4 Carrier
- ❑ Disinterment
y
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01097
Address
136 Main Street, South Glens Falls NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
{
re
, 1 Permission is hereby granted to dispose of the human re ains d ribed abo e as Indic ted.
vi
Date Issued_5/2-0/l/ Registrar of Vital Statistics - ���
- (signature)
i District Number fi 6 0 ( Place 6
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 05/21/2011 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
Mohican 20 A 3
(section) (lot number) (grave number)
•
Name of Sexton or Person ' Charge of Premises Michael Genier
(please print)
Th •Signature'' P Title Superintendent
over)
DOH-1555 (02/2004)