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Alpuche, Juanita Utrzy-i NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Juanita Alpuche Female Date of Death Age If Veteran of U.S.Armed Forces, 03/12/2023 82 Years War or Dates E.. Place of Death Hospital,Institution or WCity,Town or Village Indian Lake Town Street Address 6320 State Route 28, Indian Lake Town, New York 12842 p Manner of Death Natural Cause Accident ❑Homicide Suicide Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title a Matthew Miller Coroner . Address 172 28 Route, Inlet Town,New York 13360 Death Certificate Filed Town Of Indian Lake District Number Register Number City,Town or Village 2053 2 Burial Date Cemetery,Crematory or Facility Name 03/15/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town, New York Donation 0❑Removal Date Place Removed and/or and/or Held H Hold Address CO O 11. Date Point of fA❑Transportation Shipment Q by Common Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address Reinterment Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 01199 Address 6357 Nys Rte#30, Indian Lake, New York 12842 Name of Funeral Firm Making Disposition or to Whom i— Remains are Shipped,If Other than Above 5 Address Cr W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/15/2023 Registrar of Vital Statistics Julie A Clawson(Electronically Signed) (signature) District Number 2053 Place Town Of Indian Lake I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition )llc II) Place of Disposition (J,,.1 r tu UI • (address) UJ NIX (section) 717• (lot number L (grave number) 0 Name of Sexton or Person in Char a of Premises MCC please print) W Signature /--/ —A--, Title lYtf.mN�t7� DOH-1555(07/18)p 1 of 2 _ CI I 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#