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Galusha, Joyce Margaret # s5 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex , Joyce Margaret Galusha Female :11,--,_ Date of Death Age If Veteran of U.S.Armed Forces, 05/31/2021 84 Years War or Dates h, Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital LU • Manner of Death ©Natural Cause ❑Accident El Homicide El Suicide El Undetermined El Pending W Circumstances Investigation W Medical Certifier Name Title William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 226 0 Burial Date Cemetery,Crematory or Facility Name O6/03/2021 Pine View Crematory Entombment Address X❑Cremation Queensbury Town,New York 0 Donation 0❑Removal Date Place Removed and/or and/or Held t Hold Address N 0 Q Date Point of Cl) ❑Transportation Shipment p by Common Carrier Destination Li 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 E Remains are Shipped,If Other than Above Address CC a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/02/2021 Registrar of Vital Statistics Rp6ertAndrew Curtis(E(ectronically Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W' Date of Disposition j Z4 Place of Disposition add4A L.._ Zz--- ) W. CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premi //1 r ` ��'"A A il- Z (please riot) ioe LL1 Signature Title a m,t DOH-1555(07/18)p 1 of 2 • 4 Public Health Law Sec. 4145(2b) O l t-1 8 2 6 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#