Loading...
Goyer, Florence Irene • 4 - LI ft zr) NEWYORKSTATEDEPARTMENTOFHEALTH \\....-} Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Florence Irene Goyer Female Date of Death Age If Veteran of U.S.Armed Forces, 03/15/2023 82 Years War or Dates li— Place of Death Hospital,Institution or Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare W pManner of Death El Natural Cause Accident n Homicide Suicide Undetermined Pending ✓ Circumstances I (Investigation LU Medical Certifier Name Title O Joshua Started NP Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed Town Of Argyle District Number Register Number City,Town or Village 5750 19 ▪Burial Date Cemetery,Crematory or Facility Name 03/17/2023 Pine View Crematory ,Entombment Address ©Cremation Queensbury Town,New York ▪Donation 0• Removal Date Place Removed and/or and/or Held F- Hold Address CO 0 O. Date Point of @"l IIITransportation 5 by Common Shipment Carrier Destination El Disinterment Date Cemetery Address n Reinterment Date Cemetery Address 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 N Remains are Shipped,If Other than Above _• Address Cr LU E' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/16/2023 Registrar of Vital Statistics Shelley Mckernon(Electronically Signed) (signature) District Number 5750 Place Town Of Argyle I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition 3)t-1 tl3 Place of Disposition 17,4 U .(i�- �— LU LU (address) W N (section) (tot number) (grave number) CC g Name of Sexton or Person in Charge of Pre is / g1, aseprint) ! rt Z LU Signature Title / DOH-1555(o7/t8)p 1 of 2 71, 1. 67 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# f ,-