Moore, Stewart NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
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Permit Issued to Registration Number
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CL Permission is hereby granted to dispose of the human remains described above as indicated.
Date issued G (1 M Registrar of Vital Statistics LAX s�"'.,r'/�i(sign ure)
District Number 5 bd 1 Place 6 (54,5 rc t )5, N y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
6/26/201 Pine View Cemetery
11 Date of Disposition -Place of Disposition
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Horicon 42 C • 2
p (section) (lot number) (grave number)
a' Name of Sex n or Person in Charge of Premi s __ Connie L. Goedert
(please pant) ,
Signature �i ,_ Title
Superintendent
(over)
DOH-1555 (02/2004)
MOORE Lot No. 42 C
Address 27 Twicwood Lane, Queensbury, Ny 12804 1., Section No.
Owner Dorothy Moore Plot Horicon
Date 6/17/2014
Approx. 133 Superficial ft. @
Location Bounded on the North by Vacant, East by Vacant
West by Road and South by' Vacant
Corner Posts
Remarks 518-798-3844
Deed No. (and changes) 3855
Payment Record paid in full on 6/17/2014 ( $1 , 800.00 )
Record of Interments
2 Stewart F. Moore ( 6/26/2014 )
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Form No. 01
NAME MOORE, STEWART F.
Age: 92
Cause: Natural
Lot Own Dorothy Moore
Lot # � C Horicon
Grave # 2
Case # Concrete
Died: 6/22/2014
Interred: 6/26/2014
Undertaker: Maynard D. Baker