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Clawson, Audrey E NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Audrey E.Clawson Female Date of Death Age If Veteran of U.S.Armed Forces, 07/26/2023 87 Years War or Dates F. Place of Death Hospital,Institution or Z City,Town or Village Johnsburg Town Street Address Elderwood at North Creek W Manner of Death Natural Cause illAccident Homicide ESuicide Undetermined ❑Pending W v I—JCircumstances Investigation W Medical Certifier Name Title G Kate Sauer-Jones PA Address 112 Ski Bowl Rd,Johnsburg Town, New York 12853 Death Certificate Filed Town Of Johnsburg District Number Register Number City,Town or Village 5655 27 Burial Date Cemetery,Crematory or Facility Name 07/28/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Date Place Removed ZO❑Removal and/or Held H and/or N Hold Address 0�.. Date Point of CO❑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 CC W EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/28/2023 Registrar of Vital Statistics Jean M Comstock(Electronically Signed) (signature) District Number 5655 Place Town Of Johnsburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— a Z Date of Disposition 7 2,-ZOZ3 Place of Disposition JQ Ile«) Lreip !' pJ (addr ) 2 W CC (section) J (lot number) (grave number) CC (section) Pgs. I lf)r3 !b 1,Jerd 0 Name of Sexton or Person in Charge of Pr ises (please print) Z 17J Signature5;1-04 kfr Title cerkJ-- DOH-1555(07/18)p 1 of 2 ,F 6 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#