Killon, Joyce NEW YORK STATE DEPARTMENT OF HEALTH
y It 1 L Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joyce M. Killon Female
Date of Death Age If Veteran of U.S. Armed Forces,
' sy October 25,2012 70 War or Dates
ZPlace of Death Hospital, Institution or
City, Town or Village Minerva Street Address 41 Town Shed Road
tiixx Manner of Death X Natural Cause j Accident Homicide Suicide Undetermined —Pending
lit Circumstances Investigation
Medical Certifier Name Title
t Daniel Sooriabalan
Address
HIMN,North Creek,NY 12853
Death Certificate Filed District Number Registe5 Number
City, Town or Village Minerva 1557 f
❑Burial Date Cemetery or Crematory
Entombment October 26,2012 Pine View Crematory
Address
®Cremation 21 Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
o and/or Address
H Hold
co
a Date Point of
y Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
r
Reinterment Date Cemetery Address
Permit Issued to Registration Number
o Name of Funeral Home Alexander-Baker Funeral Home 00035
'-, Address
y 3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
r =
tt
Permission is hereby granted to dispose of the human mains_described above as indicated.
Date Issued 1O1Zto 12ts1 z Registrar of Vital Statistics ----
(signature)
: District Number 1557 Place Minerva
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
gDate of Disposition to-vet-it Place of Disposition ZOix., �r ri...-
W (address)
N
Q (section) A,, (lot number) (grave number)
p Name of Sexton or Person in Charge f Premises ? � ;
Z (please print)
tit
Signature Title Ci mtlf0't
(over)
DOH-1555 (02/2004)