Welch, Joan NEW YORK STATE DEPARTMENT OF`'HEALTFfi '
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Vital Records Section N Burial - Transit Permit
Name Firstjoan Middle N. Last
elch Sex Female
DateOo/tpeaat Age84 years If Veteran of U.S. Armed Forces,
ss11 War or Dates
1- Place of Death Hospital, Institution or
X City, Town or Village Town Of Milton Street Address Gateway House Of Peace-479 Rowland Street
▪ Manner of Death Natural Cause 0Accident 0 Homicide 0 Suicide O Undetermined ri Pending
Uf Circumstances Investigation
ui Medical Certifier Name Title
p Julia Malin Dr.
Ad r��eyser Rd, #14, Ballston Spa, Ny 12020
�Certific� Milton 5 Distr4561umber Re'44ter Number
own or
❑Burial Date 10/24/2017 Cemetery pr C�ematotryr
in iew rema o ium
['Entombment
Address
[Cremation ueensbury NY
Date Place Removed
..Z1-1❑Removal and/or Held
and/or Address
t= Hold
U) •
0 Date Point of
❑Transportation Shipment
el by Common Destination
im Carrier
Q Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Densmore Funeral Home Region Number
Name of Funeral Home
Address Sherman Avenue, Corinth Ny 12822
11 Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
Cr
ff
Permission is hereby granted to dispose of the hum. I rA ns described boy as in.' to•.
10/23/2017 g , .
Date Issued Registrar of Vital Statist � �+�►� .Ina
(signature)
District Number 4561 Place Milton
AX
>:::: I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ftl• Date of Disposition /o f IS)fl Place of Disposition f,„,k14., ( sr —
(address)
Ili
U)
CC (section) (lot number) (grave number)
• Name of Sexton or Person in Charge of Pre - es (Adel' S il .('to
( lease print)
3J Signature a Title agolfritt
(over)
DOH-1555 (02/2004)