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Dunkley, Alice Marie NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Alice Marie Dunkley Female Date of Death Age If Veteran of U.S.Armed Forces, 09/27/2023 76 Years War or Dates F,. Place of Death Hospital,Institution or WCity,Town or Village Johnsburg Town Street Address 86 Bartman Road,Johnsburg Town,New York 12811 p Manner of Death �NaturalCause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title 0 Kate Sauer-Jones PA Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed Town Of Johnsburg District Number Register Number City,Town or Village 5655 Burial Date Cemetery,Crematory or Facility Name 09/29/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Removal Date Place Removed and/or and/or Held H N Hold Address 0 d Date Point of (/) Transportation by Common Shipment Carrier Destination O Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg, New York 12885 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped,If Other than Above Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/29/2023 Registrar of Vital Statistics Jean M Con tock(ECectronica(Cy 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: W Date of Disposition /o 13 17 3 Place of Disposition r r,l E) �� C� -1TQQtu 2 (address) W t/) CC (section) s � (tot number) (grave number) Name of Sexton or Person in Charge o remises / ease print) W Signature Title i trD7 DOH-1555(07/18)p 1 of 2 Jr ec a4 7 y T .. „,.s. f 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# w