Williams, Patricia NEW YORK STATE DEPARTMENT OF HEALTH ft
Vital Records Section
`� Burial - Transit Permit
Name First Middle Last Sex
Patricia A. Williams Female
Date of Death Age If Veteran of U.S. Armed Forces,
02/01/2011 66 years War or Dates
-, Place of Death Hospital, Institution or
W City, TAr kihtga Saratoga Springs Street Address Saratoga Hospital
Manner of Death Natural Cause n Accident 0 Homicide 0 Suicide �Undetermined Pending
ILI Circumstances Investigation
ul Medical Certifier Name Title
0 Desmond Del Giacco M D
Address
59 Myrtle St, Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Number
City, Tgtu(q%MOM Saratoga Springs 4501 47
❑Burial Date Cemetery or Crematory
❑Entombment 02/03/2011 Pineview Crematorium
Address
[Cremation Queensbury N Y
Date Place Removed
8 El Removal and/or Held
and/or Address
Hold
in
0 Date Point of
CI' El Transportation Shipment
G by Common Destination
Carrier
❑Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home 00442
Address
7 Sherman Ave, Corinth, New York 12822
Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
,' Address
l
"' Permission is hereby granted to dispose of the human remain sc 'b abov1 dicated
Date Issued 02/03/2011 Registrar of Vital Statistics `
(signature)
District Number 4501 Place Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W• Date of Disposition Fc 3 j(ZOII Place of Disposition firu Value, t
a` (address)
llil
U
IX (section) /l (lot numb (grave number)
Name of Sexton or Pe on in Charge Premises ` &r,s4L(1ht( ,)a....tit
2i (please print)
l Signature �� Title CE r i.l-i Ot
(over)
DOH-1555 (02/2004)