Harvey, Joyce t
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joyce A. Harvey Female
Date of Death Age I If Veteran of U.S. Armed Forces,
June 10,2011 69 War or Dates
Place of Death Hospital, Institutior2l[Nirondack Tri-County Health Care
Z City, Town or Village Johnsburg Street Address Center
W Manner of Death Undetermined Pending
X Natural Cause Accident + f Homicide ( �Suicide
Circumstances Investigation
0
W Medical Certifier Name Title
CI Thomas Warrington
Address
H1H3N,Johnsburg,NY 12843
Death Certificate Filed Johnsburg District Number Register Number
City, Town or Village 5655
❑Burial Date Cemetery or Crematory
El Entombment June 13,2011 Pine View Crematory
Address
Ei Cremation Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
F Hold
0 Date I Point of
tan I Transportation Shipment
a by Common Destination
Carrier
Disinterment Date I Cemetery Address
Reinterment Date
r Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00035
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped, If Other than Above
2 Address
a
Permission is hereby granted to dispose of the human remain described ov indicated.
/
Date Issued (p/�i�l i( Registrar of Vital Statistics C _.C 't ��
(signature)
District Number 5655 Place Johnsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition (p-ls-it Place of Disposition -�+�Ihs) Ct1,' t0tk,_
W (address)
U)
Ce (section) )) (lot nenber) (grave number)
pName of Sexton or Pion in Ch ge of Premises � r+5�(4iv- ,..)f
iZ (please print)
Signature
Title Citi>`Mai On.
(over)
DOH-1555 (02/2004)