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Amell, Judy A
4 706 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Judy A.Amell Female Date of Death Age If Veteran of U.S.Armed Forces, 02/22/2024 72 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Johnsburg Town Street Address Elderwood at North Creek p▪ Manner of Death El Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Jennifer Donovan DO 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 9 Burial Date Cemetery,Crematory or Facility Name 02/23/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation goRemoval Date Place Removed and/or and/or Held F-N Hold Address 0 4. Date Point of U)ETransportation p by Common Shipment Carrier Destination ODisinterment Date Cemetery Address OReinterment 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 1.. 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 02/23/2024 Registrar of Vital Statistics Jean S1 Comstock(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: IH W Date of Disposition a 2 C/ J% Place of Disposition C e U�e ) j-/Apchy,.- 2 (address) W (/) CC (section) y� 1(lot nu ber) (grave number) 0 Name of Sexton or Person in Chaff - f Premj s� /�1(Y o t✓c-PC Z (p/ease print) W Signature / .e" Title e,� DOH-1555(07/18)p 1 of 2 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#