Woods Jr., James $ Sag
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
• Name First Middle Last Sex
James E.Woods Jr. Male
r. Date of Death Age If Veteran of U.S. Armed Forces,
06/20/2018 78 Years War or Dates 1957-1977
L Place of Death Hospital, Institution or
�G City, Town or Village Saratoga Springs Street Address Saratoga Hospital
1 Manner of Death a Natural Cause Ei Accident Homicide El Suicide El Undetermined n Pending
°:,` Circumstances Investigation
' ; Medical Certifier Name Title
Todd Duthaler DO
Address
211 Church St,Saratoga Springs,New York 12866
Ka Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 346
PIA
Iv al❑Burial Date Cemetery or Crematory
06/22/2018 Pineview Crematorium
❑Entombment Address
KA®Cremation Queensbury Town, New York
Date Place Removed
_. ❑Removal
and/or Held
and/or Address
• Hold
-, Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Q Disinterment Date Cemetery Address
ig
El Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
41 7 Sherman Ave,Corinth,New York 12822
FA Name of Funeral Firm Making Disposition or to Whom
;, Remains are Shipped, If Other than Above
-- Address
• Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/21/2018 Registrar of Vital Statistics John PTranck(ECectronica/TySigned)
(signature)
District Number 4501 Place Saratoga Springs, New York
VC
vm I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
E
b
Date of Disposition /25't($ Place of Disposition ,, .„. 4,�, L.,
(address)
_ (section) (Jot yytuber) (grave number)
Name of Sexton or Perso in Charge of Premises l/'.
(please inf)
Signature 4- Title t 1 Pie_
(over)
DOH-1555 (02/2004)