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Walters, Eva M
NEWYORKSTATEDEPARTMENTOFHEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Eva M Walters Female Date of Death Age If Veteran of U.S.Armed Forces, 12/26/2023 87 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Johnsburg Town Street Address Elderwood at North Creek ▪ Manner of Death ❑^ Natural Cause Accident Homicide ESuicide FlUndetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title CI Mary Stein NP Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed Town Of Johnsburg District Number Register Number City,Town or Village 5655 56 Burial Date Cemetery,Crematory or Facility Name MOO 12/27/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held H Hold Address O d Date Point of U) Transportation p by Common Shipment Carrier Destination o Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 1— Remains are Shipped,If Other than Above 5 Address CC W CI. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/26/2023 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: t— W Date of Disposition /z Z743 Place of Disposition ..1 e Ve,,,) £ � 2 (address) W N CC (section,/ (lot number) (grave number) rr 0 Name of Sexton or Person in Charge of Pr ises e.et,yinO. Z (please print) W Signature Title t?,C� DOH-1555(07/18)p 1 of 2 V 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#