Pincheon, Collette • . 31)
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
_§ Collette R.Pincheon Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/16/2018 50 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death au=Natural Cause ❑Accident ❑Homicide 0 Suicide ri Undetermined ❑Pending
Circumstances Investigation
• Medical Certifier Name Title
Timothy Waters DO
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number 7 Register Number
City, Town or Village Saratoga Springs 4501 236
❑BUrlal
Date Cemetery or Crematory
04/18/2018 Pineview Crematorium
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
, Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Q 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
F' Address
r Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/17/2018 Registrar of Vital Statistics John rn'ranck(f(ectronica1tySigned)
e (signature)
District Number 4501 Place Saratoga Springs, New York
•• 1 certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
fDate of Disposition q I�� �I� Place of Disposition ,h
(address)
fi=t^e
(section) (191 pumber) r (grave number)
Name of Sexton or Person in Charge of Pre ises I/' hot J ,art
(pleasel�rint)
Signature Gam' "f1 Title (WM itZ
(over)
DOH-1555(02/2004)