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Dunton, Jo 6 NEW YORK STATE DEPARTMENT OF HEALTH,.--- T Vital Records Section94 Burial - Transit Permit Name First Middle Last Sex 4. Jo Anne Bunton Female Date of Death Age '`.If Veteran of U.S. Armed Forces, :'•f July 30, 2016 61 War or Dates r Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address 7 Union Street,Apartment 2B Manner of Death n Natural Cause Accident I I Homicide Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name a d c. n Title p (� rr Q, U '� c �( R. i:if Address 'elf on Si. 6 .c cm I l/t u J Nkj 1 ( k-V V iiirr, Death Certificate Filed I C (( \ District Number Register 14 e fr City, Town or Village C Cn13 a � / ❑Burial Date Cemetery or Crematory El Entombment August 2, 2016 Pine View Crematorium Address ©Cremation 51 Quaker Road, Queensbury,NY 12804 Date Place Removed ZZ n Removal and/or Held and/or Address �' Hold co O Date Point of O. Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address n Reinterment Date Cemetery Address �Ir Permit Issued to Registration Number r Name of Funeral Home Regan Denny Stafford Funeral Home 01443 r fr Address r.•: }fJ 53 Quaker Road, Queensbury, NY 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address r Permission is hereb granted to dispose of the human remains de r'be ab e a i 'cated. yr � r Date Issued Q g"Oil 201 e Registrar of Vital Statistics --1 - Si:?:. j�"/� (signature) District Number 5�e/ Place CA3f,.,, / ; `!5, , ,— :rr} I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition I/4(/(, Place of Disposition ertt U,i..,/ ��+matot't. ,- 2 (address) W CO rt (section) (lot number) c (grave number) pName of Sexton or Person in Charge of Premises tL tc 11..r- 3do114 -- Z (( lease print)t Signature a .4 Title Ilikti ( t (over) DOH-1555(02/2004)