Bora, Julie Ann I
I 'LF I/ Z42I
NEW YORK STATE DEPARTMENT OF H EALTH
Bureau of Vital Records Burial - Transit Permit a
Name First Middle Last Sex
JuNe Ann Bora Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/27/2022 84 Years Waror Dates
F. Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address 19 Hunter Street,Glens Falls,New York 12801
El Mannerof Death Ei Natural Cause DAcddent 0 Homicide Suicide rillndetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 Sean Campenie NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed City Of Glens Falls District Number Register Number
Cit ,Town or Villa, 5601 187
Burial Date Cemetery,Crematory or Facility Name
0 ddress 22
Address Pine View Crematory
Entombment
ECremation Queenebtey,New York
DDonation
❑Removal Date Place Removed
F and/or and/or Held
gA Hold Address
0 -
d Date Point of
ff)❑Transportation
CI Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
DReinterment Date Cemetery Address
Pe unit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Otherthan Above
5 Address
CC
Ill
IL Permission is hereby granted to dispose of the human remains described above as Indicated.
Date Issued 03/30/2022 Registrar of Vital Statistics Nsgan Nan(Thetstmualty Signed)
(signature/
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: /��
Date of Disposition I t 2Z Place of Disposition 'I ja4 V` j a
W
2 (adders)
uJ
UJ
cr (section( (/%number) (gre It.number(
S Name of Sexton or Person in Charge o Premisesi 4 r'► ti- l mi
lt
/p/ea pint) /�
Ill Signature .! Title ` m �
DOH 1555(o7/18)pi of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#