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Ure, June May 0� NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex June May Ure Female Date of Death Age If Veteran of U.S.Armed Forces, 01/20/2020 59 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Hudson Falls Village Street Address 13 Delaware Avenue,Hudson Falls Village,New York 12839 `p Mannerof Death Natural Cause Accident Homicide ❑Suicide Undetermined ©Pending Circumstances Investigation W Medical Certifier Name Title Robert Lemieux Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed District Number Register Number City,Town or Village Hudson Falls Village 5726 1 Fj Burial Date Cemetery,Crematory or Facility Name 01/27/2020 Pine View Crematorium Entombment Address FRICremation Queensbury Town,New York ❑Donation ZZ Fj Removal Date Place Removed and/or and/or Held N Hold Address O a Date Point of V1 ❑Transportation p 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 F Remains are Shipped,If Otherthan Above M Address lx W 0' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/21/2020 Registrar of Vital Statistics Cynthia,4 Bardin(ECectronicaCCySigned) (signature) District Number 5726 Place Hudson Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: h- WDate of Disposition t--17-ZOZt9 Place of Disposition �11'►Q�J L/�rna4'- W (address] W Cl) (section) (l umber) (grave number) Q 0 Name of Sexton oZPer i harge of Premises f e Z (please print) W Signature Title DOH-1555(07/18)p of 2 Public Health Law Sec. 4145(2b) 013260 Receipt Human remains of.,5 delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#