Lindsey, Bernard4 610
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last
Sex
Bernard H Lindsey
I Male
Date of Death
Age
If Veteran of U.S. Armed Forces,
09/14/2019
76 Years
War or Dates
Place of Death
Hospital, Institution or
Z
City, Town or Village Saratoga Springs
Street Address Saratoga Hospital
p
Manner of Death 0 Natural Cause Accident Homicide Suicide Undetermined Pending
W
Circumstances Investigation
W
Medical Certifier Name Title
Rodney Ying MD
Address
211 Church St, Saratoga Springs, New York 12866
Death Certificate Filed
District Number
Register Number
City, Town or Village Saratoga Springs
4501
485
Burial
Date Cemetery, Crematory or Facility Name
Entombment
09/17/2019 Pineview Crematory
Address
Cremation
Queensbury Town, New York
Donation
Removal
Date
Place Removed
OZ
and/or Held
H
and/or
Hold Address
N
O
(L
Date Point of
U)
p
â Transportation Shipment
by Common
Carrier
Destination
Disinterment
Date
Cemetery Address
1EIReinterment
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
tâ
Remains are Shipped, If Other than Above
Address
i1L
W
(L
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/16/2019 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 Place of Disposition
LU
a
/address)
to
W
IM
(section) / l/otnumberl (grave number)
1A4r
0
Name of Sexton or Person in Charge of Premises ` (f s
/p/ se print)
W
Signature /_ Title
DOH-1555 (07/18) p t of 2
Public Health Law Sec. 4145(2b) 012536
Receipt
Human remains of
Pine NriwW-Cemetery
Official
delivered on 201
Representing the funeral home named I on burial permit
Funeral Directors Reg. or License # , , " -4 - -