Baird, June NEW YORK STATE DEPARTMENT OF HEALTH E.' <
Vital Records Section Burial - Transit Permit
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Name First Middle Last Sex
June M. Baird F
Date of Death Age If Veteran of U.S. Armed Forces,
02/25/2011 80 War or Dates
F: Place of Death Hospital, Institution or
City, Town or Village Beacon Street Address Beacon
IIIW Manner of Death ElNatural Cause ❑Accident ❑Homicide ❑Suicide ri❑Undetermined ❑Pending
Circumstances Investigation
ill Medical Certifier Name Title
Aruna K. Peddireddy M.D.
Address
10 Hastings Drive, Beacon, NY 12508
Death Certificate Filed District Number Register Number
City, Town or Village Beacon 1301 17
❑Burial Date Cemetery or Crematory
❑Entombment 3/2/2011 Pine View rematory
Address �/. /Y((
Cremation "==_=_,`.'�"�" z "� �r✓C� l/
Date Place Removed
Z Removal and/or Held
❑and/or
� Address
Hold
In
0 Date Point of
Transportation Shipment
0 by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Miller Funeral Home 01222
Address
35 W Main Street, P.O. Box 718, Indian Lake, NY
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
I
III
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Permission is hereby granted to dispose of the h an rep • de-• ib.. ab•ve as indipated.
1116,
Date Issued 02/28/201 Registrar of VitaliNR s , ,,, o-
(signature)
District Number 1301 Place Beacon, New Y:rk
I
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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El Date of Disposition . -4-1t Place of Disposition 1✓u. Vrt,�� (�t'Cih.ttcrluv%
(address)
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CO
C (section) (lot nu r) (grave number)
pName of Sexton ppp��}""" Person in Ch ge of Premises r�5 vrce
Z iti � J (please print)
Signature ((( /-t., Title Me Ail•Tci
(over)
DOH-1555 (02/2004)