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Yune, Yong Sun NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Yong Sun Yune Female Date of Death Age If Veteran of U.S.Armed Forces, 04/06/2021 82 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 57 Waverly Place,Queensbury Town, New York 12804 ,p Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending VCircumstances Investigation WG Medical Certifier Name Title Lauren Dinsmore PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 90 ❑Burial Date Cemetery,Crematory or Facility Name 04/09/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury,New York ❑Donation Q ❑Removal Date Place Removed and/or and/or Held pN Hold Address 0 A Date Point of t/) ❑Transportation a by Common Shipment Carrier Destination Date Cemetery Address El Disinterment ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom t.. Remains are Shipped,If Other than Above a Address lW O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/08/2021 Registrar of Vital Statistics Caroline JfiClegareeBarber(ECectronica1CySigned) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition y`O I Place of Disposition j A U j,t.4J t'r-t°i . tu /addLesl W N Q (section) ,/ ) (loto number/ (grave number) Ar g Name of Sexton or Person in Cha a of Premi s Al�'' �' „,,c (please print) W Signature ? r�rr✓�'`/ Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014701 Receipt Human remains of delivered on ' 4 , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#