Piiscofsky, Joyce Ellen ,F
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NEWYORKSTATE DEPARTMENT OF H EALTH ‘•'' Burial - Transit Permit
Bureau of Vital Records
Name First Middle lest Sex
Joyce Elan Pliscofsky Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/20/2022 88 Years Waror Dates
1.,. Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
UJ
Manner of Death Undetermined Pendin
W ID Natural Cause Accident Homicide Suicide g
O Circumstances Investigation
W Medical Certifier Name Title
O Aaron Heckler PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Fad District Number Register Number
Cit E,Town or Village 5601 536
Burial Date Cemetery,Crematory or Facility Name View
'R: ,10/24/2022 Pine Crematory
Entombment Address
aCremation QueensMxy Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
F
• Hold Address
fA❑Transportation Date Point of
0 by Common Shipment
Carrier Destination
DisintermentDate Cemetery Address
Date Cemetery Address
El Re interment
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
f.. Remains are Shipped,If Otherthan Above
2 Address
IX
LLt
U. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/24 2022 Registrar of Vital Statistics Milan l'o�rr(T4c:trorsscagS
(stnatnre)
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:
Z ' I
W Date of Disposition is 175 IX Place of Disposition -`'AIL.,_ tar.
2 (add essl
W
NCC (section) 4 (lot number/ (Brannumber)
0 Name of Sexton or Person in Charge o remises
Ode Pried
W Signature Title r mN r N
DOH-1.555(07/t8)p t of 2
tri 16 4
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#