Burke, Barbara NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Barbara Burke Female
Date of Death Age If Veteran of U.S. Armed Forces,
06/07/2017 68 years War or Dates
h- Place of Death Hospital, Institution or
Z City, ToWt t XIxg,9CX Saratoga Springs Street Address Saratoga Hospital
W Manner of Death Natural Cause El Accident ❑Homicide 0 Suicide ❑Undetermined 0 Pending
Circumstances Investigation
W Medical Certifier Name Title
C1 Rodney Ying MD
Address
59 Myrtle Street Saratoga Springs. Ny
Death Certificate Filed District Number Register Number
City, T01I(!'tO4lKVitw ;XX Saratoga Springs 4501 277
❑Burial Date Cemetery or Crematory
06/08/2017 P ineview Crematory
❑Entombment Address
DCremation ;: ueensbury, N Y
Date Place Removed
Z Removal and/or Held
2❑and/or Address
H Hold
0 Date Point of
❑Transportation Shipment
G by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
• Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home • 00448
Address
7 Sherman Ave; Corinth, New York 12822
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
g Address
it
W
a Permission is hereby granted to dispose of the human remains ibe abos ' dicated.
Date Issued 06/08/2017 Registrar of Vital Statistics
(signature)
District Number 4501 Place Saratoga Springs
I- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z i�.
W Date of Disposition DI12 WI Place of Disposition 4vJ ._ C
g (address)
W
(section) (lot number) ,,t (grave number)
pName of Sexton or Person in Charge of Premises Ck"zr �'�^^"t✓
Z (pl�se print) p
ill Signature Title // C ►'f"4--
(over)
DOH-1555 (02/2004)