Bradley, Jean it dig
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
' Jean M Bradley Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/02/2018 74 Years War or Dates
Place of Death Hospital, Institution or
.-i City,, Town or Village Sarato.a Sprint s Street Address Sarat
oga 9 p Hospital
Manner of Death a Natural Cause 0 Accident 0 Homicide 0 Suicide riUndetermined n Pending
FAr- Circumstances Investigation
Medical Certifier Name Title
Enrico Bravo MD
Address
• 211 Church St,Saratoga Springs,New York 12866
• Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 430
❑Burial Date Cemetery or Crematory
08/03/2018 Pineview Crematory
;ten 0 Entombment Address
®Cremation Queensbury Town, New York
t
Date Place Removed
❑Removal and/or Held
I and/or Address
Hold
Date Point of
- Li Transportation Shipment
by Common Destination
Carrier
:
tv-
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
iv
P,74Aermit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
46
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
t Remains are Shipped, If Other than Above
-. Address
oi Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/02/2018 Registrar of Vital Statistics John 2r'Franck(E&tronica1tySigned)
(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 $13 IN Place of Disposition cf (
(address)
."
(section) (lotf�'mber) (grave number)
• Name of Sexton or Person in Charge of Premises I Pt� 5t4ti4
- (please nt)
Signature Title NAIR Pit
(over)
DOH-1555 (02/2004)