Boor, June 11 Zo7
NEW YORK STATE DEPARTMENT OF HEALTH '
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
June Boor Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 7,2018 92 War or Dates NA
F Place__of Death Hospital, Institution or
Z City 1 nv$or Village Town of Wilton,NY Street Address Home of the Good Shepherd,Wilton,NY
p Manner of Death ❑X Natural Cause E Accident Li Homicide ❑Suicide 1-1 I Undetermined I Pending
Circumstances Investigation
W Medical Certifier Name lynn M. Keil Title
CI lynn
Address
161 Carey Rd.,Queensbury,NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village Town of Wilton,NY �/, S 7/9 /,J
El Burial Date Cemetery or Cre atory
ElMarch 9,2018 Pine View Crematory
Entombment Address
®Cremation Quaker Rd.,Queensbury,NY
Date Place Removed
ZZ n Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
O. I I Transportation Shipment
p by Common Destination
Carrier
n Disinterment Date Cemetery Address
n Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd.,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
W
O. Permission is hereby granted to dispose of the human remains described above as
indicated.
Date Issued J �/ P Registrar of Vital Statistics !� �fr����r �
/ / (signature)
District Number /��/,,,�,/' Place '/'i /'7. '//)i
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z p //��
�
w Date of Disposition 3 3Ji I1$ Place of Disposition ?PA—, 441or
W (address)
CO
lY (section) (lot number (grave number)
QName of Sexton or Person in Charge of Premises ,,I—.
'Z /J (plJase print)
4
Signature (,� Title f ftelft5l'l.
(over)
DOH-1555(02/2004)