June, Patricia 1 It It/2
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section , Burial - Transit Permit
Name First Middle Last Sex
Patricia S. June Female
- Date of Death Age If Veteran of U.S. Armed Forces,
July 31, 2018 86 War or Dates
` Place of Death Hospital, Institution or
Z City, Town or Village Warrensburg Street Address 26 Woodward Ave.
fl' Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
W' Circumstances Investigation
Uj Medical Certifier Name Title
Reeves MD
Address
Iron Gate Center,Glens Falls,NY
Death Certificate Filed District Number Register Number
City, Town or Village Warrensburg 5660
❑Burial Date Cemetery or Crematory
El Entombment August 2,2018 Pine View Crematory
Address
❑X Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
ZZ n Removal and/or Held
and/or Address
H Hold
N
O Date Point of
NI I Transportation Shipment
Q by Common Destination
Carrier
Date . Cemetery Address
n Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
ir
ui
n.
Permission is hereby granted to dispose of the human remains cr'bed above as indicated.
Date Issued 8-1-18 Registrar of Vital St sties ,
(signature)
District Number 5660 Place Warrensburg,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
�Z /2Its DispositionPKU..- err.**__..
Date of Disposition � Place of
W (address)
co
O (section) (lo umb r) (grave number)
O p
ZName of Sexton or Person in Charge of Premises k -Jei+uf
W
(please rint)
A %
Signature i Title t1 E4l1)5{1----
(over)
DOH-1555 (02/2004)