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Fuller, June "tr NEW YORK STATE DEPARTMENT OF HEALTH 0'4 .t.... Burial ILL( Vital Records Section - Transit Permit Name First Middle Last Sex June Ann Fuller Female Date of Death Age If Veteran of U.S. Armed Forces, March 3,2015 65 War or Dates Place of Death Hospital, Institution or City, Town or Village Queensbury Street Address 394 Dix Ave. Manner of Death n Natural Cause Accident n HomICide Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title sa Gerard Abess MD Address :m HH1I1,9 Carey Rd.,Qdeensbury,NY 12804 $f : District Number Register Number Death Certificate Filed i a City, Town or Village Queensbury 5cP51 11:0 5667 ❑Burial Date Cemetery or Crematory March 6,2015 Pine View Crematory ❑Entombment Address ©Cremation 21 Quaker Rd., Queensbury,NY 12804 Date Place Removed Zn Removal and/or Held and/or Address 1' Hold N Date Point of a. Transportation Shipment Q by Common Destination Carrier n Disinterment Date Cemetery Address Reinterment Date Cemetery Address @' s Permit Issued to Registration Number pap Name of Funeral Home Alexander-Baker Funeral Home 00037 ;.x Address 3809 Main Street,Warrensburg,NY 12885 ma Name of Funeral Firm Making Disposition or to Whom , Remains are Shipped, If Other than Above Address -; Permission is hereby granted to dispose of the human remains described above as indicated. � Date Issued 3-4-15 Registrar of Vital Statistics (signature) District Number 56,5 7 Place Queensbury> NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z // ILI Date of Disposition 3�i jr Place of Disposition �*t v (,w tlrb..- (address) W CC (section) (lot number (grave number) ap Name of Sexton or Person in Charge of Premises rr,+ ..ii,fv01 Z ( lease print) W Signature a A Title (ILVA ' (over) DOH-1555(02/2004)