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Pope, Joan
• NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Joan Pope Female Date of Death Age If Veteran of U.S.Armed Forces, 06/05/2021 80 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Rochester Street Address Rochester General Hospital p Manner of Death © Natural Cause Accident rj Homicide ❑Suicide ❑Undetermined Pending W U Circumstances Investigation W Medical Certifier Name Title 0 Taylor Michels PA Address 1425 Portland Ave,Rochester,New York 14621 Death Certificate Filed District Number Register Number City,Town or Village Rochester 2700 4129 ElBurial Date Cemetery,Crematory or Facility Name 06/07/2021 Pine View Crematory El Entombment Address lCremation Queensbury Town,New York ❑Donation g Removal Date Place Removed and/or and/or Held H Hold Address 0 d Date Point of N �Transportation Shipment Q by Common Carrier Destination Date Cemetery Address EjDisinterment Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 01199 Address 6357 Nys Rte#30, Indian Lake,New York 12842 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address CC W C' Permission is hereby granted to dispose of the human remains desc ad above as indicated. Date Issued 06/06/2021 Registrar of Vital Statistics Michael Mendoza, MD,MPH(Electronically Signed) (signature) District Number 2700 Place Rochester, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: � f Z Date of Disposition (p(']( Z( Place of Disposition ` 1 ' . a-- UJ (a�dress) W CC (section) lot number) (grave number) /� 0 Name of Sexton or Person in Charge of Pre esf' (please rint) tL Title Cr sf Signature DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 1,4 8 3 5 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#