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McCormac, Joyce R NEW YORK STATE DEPARTMENT OF HEALTH C.....,..-*" 4 23 Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Joyce R McCormac Female Date of Death Age If Veteran of U.S.Armed Forces, 03/08/2023 96 Years War or Dates • Place of Death Hospital,Institution or ZCity,Town or Village Wilton Town Street Address 60 Waller Road,Wilton Town,New York 12831 Manner of Death ❑X Natural Cause Accident 0 Homicide ESuicide ❑Undetermined riPending W Circumstances Investigation �i Medical Certifier Name Title C� William Borgos MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Wilton District Number Register Number City,Town or Village 4569 20 Burial Date Cemetery,Crematory or Facility Name 03/13/2023 Pine View Crematory Entombment — Address n ©Cremation Queensbury,New York, USA MDonation Removal Date Place Removed and/or Held p and/or N Hold Address O a. Date Point of N Transportation a by Common Shipment Carrier Destination Date Cemetery Address Disinterment ;` II Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/13/2023 Registrar of Vital Statistics Susan Ba&win(ECectronica1Cy Signed) (signature) District Number 4569 Place Town Of Wilton I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 3)1.3 I L3 Place of Disposition tti a (address) W Q (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises ", L._ z / (plse print) W Signature Title DOH-1555(07/18)p 1 of 2 J167d Public Health Law Sec. 4145(2b) Receipt Human remains of 7 delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#