Winslow, Alfred f i II gS)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
J Name First Middle Last Sex
Alfred J.Winslow Male
Date of Death Age If Veteran of U.S. Armed Forces,
11/09/2017 71 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 0 Accident Homicide ❑Suicide
Undetermined 0 PendingCircumstances Investigation
Medical Certifier Name Title
Jason Bemad MD
6;s Address
211 Church St,Saratoga Springs,New York 12866
F Death Certificate Filed District Number Register Number
gi
City, Town or Village Saratoga Springs 4501 553
❑Burial Date Cemetery or Crematory
11/13/2017 Pineview Crematory
['Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
El Removal and/or Held
and/or Address
Hold
Date Point of
0 Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
it Address
tlsj
7 Sherman Ave,Corinth,New York 12822
31 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.
ti, Date Issued 11/11/2017 Registrar of Vital Statistics John P Franck Electrorticalfysigned
(signature)
District Number 4501 Place Saratoga Springs, New York
01
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition OP 1q Place of Disposition ().,.i (�r�r�c. ,r IN.,
(adddrrress)
(section) Aot number) (grave number)
Name of Sexton or Person in Charge of Premises AN(plea aprint)
S t�^i t
Signature 12 Title k
(over)
DOH-1555(02/2004)