Galudhs, Gertrude A. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Iko
Last Sex
Gertrude A.G usha Female
Date of Death Age If Ve rces,
04/28/2020 68 Years War r Dates:*
Place of Death Hospital,Institution or
z City,Town or Village Corinth Town Street Address 56 Antone Mountain Road Lot 27,Corinth Town,New York 12822
W Manner of Death Undetermined Pending
0 Ri Natural Cause Accident Homicide Suicide
W Ci(cumstances Investigation
C Medical Certifier Name Title
Susan Hayes-Mass Coroner
Address `a
40 McMaster Street,Ballston Spa,New York 12020
Death Certificate Filed District Number Register Number
City,Town or Village Corinth 4553 14
❑Burial Date Cemetery,Crematory or Facility Name
04/29/2020 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
❑Donation
Date Place Removed
0 Removal and/or and/or Held
P
U)
Hold Address
dDate Point of
U) Transportation Shipment
p by Common
Carrier Destination
ElDisinterment Date Cemetery Address
ElReinterment 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
tL
W
(L Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/29/2020 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 dispo d of in accordance with this permit on:
f— U
W Date of Disposition I Ili 11,0 Place of Disposition !1"4. �� Z /address
2
W
N (section) llot nfumber) (grave number)
IM
Name of Sexton or Person in Ch rge of Premis s-5 "N5
TT
(please print)
Z
W Signature Title nez
DOH-1555(07/18)p 1 of 2
i
Public Health Law Sec. 4145(2b) J 1 6 6
Receipt
Human remains of ivered on , 20_ {
a
Pine View Cemetery Representing the funeral home named on burial permit
Offici Funeral Directors Reg.or License#