Tracy, Troy K. Alto
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Troy K Tracy Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/14/2020 56 Years War or Dates
H Place of Death Hospital,Institution or
WCity,Town or Village Corinth Town Street Address 75 Stark Road,Corinth Town,New York 12822
`3 Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
U Circumstances Investigation
Uj 0 Medical Certifier Name Title
Susan Hayes-Masa Coroner
Address
40 McMaster Street,Ballston Spa,New York 12020
Death Certificate Filed District Number Register Number
City,Town or Village Corinth 4553 01
Burial Date Cemetery,Crematory or Facility Name
01/16/2020 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Z ❑Removat Date Place Removed
and/or and/or Held
H
N Hold Address
O
(- Date Point of
U) Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 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
Address
W
(L Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/16/2020 Registrar of Vital Statistics Rose E Farr(Electronically Signed)
/signature)
District Number 4553 Place Corinth, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F
Z Date of Disposition IO Place of Disposition t eO—
LU /address)
W
2 (section) /lot numbe /grave number)
GName of Sexton or Person in Charge of demises 3 s i
Z 1-se print)
W Signature Title Ir,=,0 �7f
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 01 3 2 5 4
Receipt
Human remains of ' ' = delivered on `f, , 20-
r
Pine View Cemetery Re senting the funeral home named on burial permit
Official Funeral Directors Reg.or License#