Scranton, Sally NEW YORK STATE DEPARTMENT OF HEALTH Z3
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
ft Sally I Scranton Female
'' Date of Death Age If Veteran of U.S. Armed Forces,
03/18/2018 58 Years War or Dates
Place of Death Hospital, Institution or
- City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death®Natural Cause ❑Accident El Homicide ❑Suicide 11 Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Numan Rashid MD
._ Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 170
❑BUrlal Date
Cemetery or Crematory
03/20/2018 Pine View Crematory
❑Entombment Address
. ®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
r°Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
_ Address
s 7 Sherman Ave,Corinth,New York 12822
—
g: . 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 03/20/2018 Registrar of Vital Statistics John PTranck(EfectronicallySigned)
(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:
Date of Disposition 3'21,it$ Place of Disposition CA-- AN--
-
(address)
(section) i (lot number) (grave number)
Name of Sexton or Person in Charge of Premises Z.,'t -t,it
/�j ease pon)
-'- Signature /� ar Title a2piiii112
(over)
DOH-1555 (02/2004)