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Gonyo, Joyce 33 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Joyce J.Gonyo Female Date of Death Age If Veteran of U.S. Armed Forces, 01/04/2018 77 Years War or Dates Place of Death Hospital, Institution or "` City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause El Accident Homicide Suicide El Undetermined ri Pending Circumstances Investigation Medical Certifier Name Title Shahid Ahmed MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 5 ❑Burial Date Cemetery or Crematory 01/09/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 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 01/08/2018 Registrar of Vital Statistics wp6ertA Curtis(ElectronicadySigned) (signature) District Number Place 5601 Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition j / 9 118 Place of Disposition 4,4110�'+"' (address) (section) /f lot number (grave number) Name of Sexton or Person in Charge of Pre ises a .iltf ( ease print) Signature �" � Title fR � Pt (over) DOH-1555 (02/2004)