Woodcock, Scott E. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Scott E Woodcock Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/11/2020 55 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital
p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
WMedical Certifier Name Title
0 Mikhail Mavashev MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 95
❑Burial Date Cemetery,Crematory or Facility Name
02/12/2020 Pineview Crematory
Entombment Address
aCremation Queensbury,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
O
0- Date Point of
N 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
II— Remains are Shipped,If Other than Above
2 Address
Q
W
(L Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/12/2020 Registrar of Vital Statistics John Paul Franck(Electronically Signed
/signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 2/13)Za Place of Disposition
W (address)
W
N (section) /!ot number) (grave number)
2
0 Name of Sexton or Person in Charge pf Premises
(p ase print
W Signature Title `
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) 0 i 31 3 3 9
Receipt
Human remains of delivered on 120
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#