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Cestaro, Joan E. II i1 - NEW YORKSTATE DEPARTMENTOF HEALTH Burial - Transit Perit Bureau of Vital Records Name First Middle Last Sex Joan E Cestaro Female Date of Death Age If Veteran of U.S.Armed Forces, 06/01/2021 72 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Johnsburg Town Street Address Elderwood at North Creek W Manner of Death EI Undetermined Pending r0 © Natural Cause Accident 1=1Homicide Suicide W Circumstances Investigation W Medical Certifier Name Title 0 Michael Miles MD Address 112 Ski Bowl Rd,Johnsburg Town,New York 12853 Death Certificate Filed District Number Register Number City,Town or Village North Creek 5655 19 ▪Burial Date Cemetery,Crematory or Facility Name 06/02/2021 Pine View Crematory Entombment Address ▪Cremation Queensbury Town,New York ▪Donation Z Removal Date Place Removed - and/or and/or Held H- Hold Address N 0 Date Point of N) ❑Transportation Shipment 5 by Common Carrier Destination Date Cemetery Address ElDisinterment 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 i... Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/02/2021 Registrar of Vital Statistics 1(dth(een C.Gorak( (ectronica1Ty Signed) (signature) District Number 5655 Place North Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W~ �J r,..,- Date of Disposition �� Place of Disposition �w+t�L -0 l 2 (address) W U) Cr (section) _(lot number) (grave number) O Name of Sexton or Person in Charge of Premises ��I,1 "��A i� Q (pitibse print) ,fit W �../ Signature Title C `q ug DOH-1555(o7/i8)p 1 of 2 Public Health Law Sec. 4145(2b) 1 4 8 9 9 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#