Hughes, June M ti
( LF) ,
NEW YORKSTATE DEPARTMENT OF HEALTH '- m✓*/ Burial - Transit Permit
Bureau of Vital Records '
Name First Middle Last Sex
June M Hughes Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/07/2022 78 Years War or Dates
n or
Hospital,Institution Place of Death P W Glens Falls Hospital
P City,Town or Village Glens Falls Street Address
p Manner of Death Z Natural Cause IllAccident ❑Homicide Suicide Undetermined Pending
W Circumstances Investigation
4 Medical Certifier Name Title
Q Asim Chaudry MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 614
Burial Date Cemetery,Crematory or Facility Name
INNOINI 12/13/2022 Pine View Crematory
Entombment Address
MCremation Queensbury Town, New York
IIIDonation
0❑Removal Date Place Removed
and/or and/or Held
F— Hold Address
N
0
O. Date Point of
Cl)OTransportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
lilDisinterment
1 Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Brewer Funeral Home Inc 00211
Address
24 Church Street PO Box 500,Lake Luzerne,New York 12846
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/09/2022 Registrar of Vital Statistics Megan Nolin(Electronically 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:
I—
• Date of Disposition i2 i I s .I it Place of Disposition ' L b ---�
2 (address)
W
N
Q (section) 7`� lot number) cr. (grave number)
/ l
..,,s,
O Name of Sexton or Person in Charg of Premises �— '
p (p ase print)
W Signature Title ` roCm4
DOH-1555(07/18)p 1 of 2
•
• '?I 649
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#