Towers Jr., Earl NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Earl D. Towers Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
03/11/2017 93 years War or Dates
Place of Death Hospital, Institution or
W
City, Toll-kW x Saratoga S rings Street Address Wasl He al h Care C nt
0 Manner of Death�,pIatural Cause Accident ❑Homicide ❑Suicide Undteterminec Pending
W Circumstances Investigation
W Medical Certifier Name Title
Q Diane Westbrook N P
Address
131 Lawrence Street, Saratoga Springs, N Y
Death Certificate Filed District Number Register Number
City, ToviaSt1)0130tXX Saratoga Springs 4501 130
['Burial Date Cemetery or Crematory
1.4 DEntombment Address 03/13/2017 PineviPw Crematory
❑premation Queensbury, N Y
Date Place Removed
Z ri Removal and/or Held
and/or Address
ii Hold
0 Date Point of
ai 0 Transportation Shipment
0 by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home 00448
Address
7 Sherman Ave, Corinth, New York 12822
Name of Funeral Firm Making Disposition or to Whom
ji Remains are Shipped, If Other than Above
2 Address
IX
III
Permission is hereby granted to dispose of the human rem . sc ' ed av indica d.
Date Issued 03/13/2017 Registrar of Vital Statistics
(signature)
District Number 4501 Place Saratoga Springs
f I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
lW Date of Disposition 3114 0 Place of Disposition ��,i\is.v%) (°, c`torla..
2 (address)
Ili
CO
IX (section) (lot number) (grave number)
Name of Sexton or Person in Charge of P mises i1 r9 �v"k l
Z (pl se print)
lW Signature � P Title CRr toFtrbi.,
(over)
DOH-1555 (02/2004)