Savoie, James W. NEW YORKSTATE DEPARTMENT OF HEALTH A
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
James W Savoie I Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/10/2020 81 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
W Manner of Death Undetermined Pending
G �Natural Cause �Accident �Homicide �Suicide � � g
u.� Circumstances Investigation
W Medical Certifier Name Title
0 Timothy Reed MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 26
Burial Date Cemetery,Crematory or Facility Name
01/13/2020 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
z Removal Date Place Removed
and/or and/or Held
H N Hold Address
O
(L Date Point of
U) Transportation Shipment
p by Common
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
1- Remains are Shipped,If Other than Above
Address
IM
Is Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/13/2020 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:
~ ri
Z Date of Disposition 13 126 Place of Disposition tv
W /address/
W
N (section) lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises r:) I
Z (ple a print)
W Signature Title
DOH-1555(07/18)p 1 of 2
I
Public Health Law Sec. 4145(2b) i 13 2 9
Receipt
Human remains of delivered on , 20.-
Pine View Cemetery presenting the funeral home named on burial permit
Official Funeral Directors Reg.or License#