Palmatier, Sandra Y. 1-.- #Hl9
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Sandra Y Palmatier Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/22/2020 89 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
W
p Manner of Death FRI Natural.Cause ❑Accident Homicide ❑Suicide ❑Undetermined ❑Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
13 Joseph Hayes MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 244
❑Burial Date Cemetery,Crematory or Facility Name
04/24/2020 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
N
~ Hold Address
O
4. Date Point of
(A 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
2 Address
Q
W
tZ Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/23/2020 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:
F-
W Date of Disposition 41-23-2�02d Place of Disposition h ev r C!e ,,,
LU /address)
W
(n /sedionJ tiotnumbe`r) /grave number)
0 Name of Sexton or Person i a e of Premises vb� r.a �G�Y)e-lr�
/lease print)Z
W Signature Title (�/&-.ti►Giia '�
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#