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Horyczun, Kathryn Ann 44 Y23 NEW YORK STATE DEPARTMENT OF HEALTH 1414 Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kathryn Ann Horyczun Female Date of Death Age If Veteran of US.Armed Forces, 06/24/2023 66 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 152 Elmhurst Drive,Queensbury Town, New York 12804 0 Manner of Death ❑X Natural Cause Accident El Homicide Suicide Undetermined In Pending W Circumstances Investigation W Medical Certifier Name Title C Adrianna Earl Other Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 95 Burial Date Cemetery,Crematory or Facility Name 06/26/2023 Pineview Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held F Hold Address to 0 d Date Point of t/)❑Transportation Shipment p by Common Carrier Destination o Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 1.. Remains are Shipped,If Other than Above a Address CC W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/26/2023 Registrar of Vital Statistics Caroline Jfi(Cegarcfe Barber(ECectronica((y Signed) (signature/ District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: _' IH W Date of Disposition b/Z$(Z3 Place of Disposition ��.,,�.- kit*—'-- (address) W CCCC (section) /�(lot number (grave number) 8 Name of Sexton or Person in Cha/ mises r' rt z (p ase print) �,� W /�,"' Signature Title " DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt 1 Human remains of • delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#