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Walker, Alice NEW YORK STATE DEPARTMENT OF HEALTH 1 3$ Vital Records Section r Burial - Transit Permit Name First Middle Last Sex Alice M. Walker Female Date of Death Age If Veteran of U.S. Armed Forces, 07/31/2011 79 years War or Dates Place of Death Hospital, Institution or w City, ToXXXX VelagitX Saratoga Springs Street Address Saratoga Hospital p Manner of Death©,Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending UJ Circumstances Investigation Medical Certifier Name Title Stephen Offord Md Address 211 church Street, Saratoga Springs, Ny 12866 Death Certificate Filed District Number Register Number City, TatliVdt WOW Saratoga Springs 4501 350 ❑Burial Date Cemetery or Crematory 08/02/2011 Pineview Crematorium ❑Entombment Address EiCremation Queensbury N Y Date Place Removed ❑Removal and/or Held 2and/or Address H Hold tl) O Date Point of to Li EL 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 ,. Remains are Shipped, If Other than Above • AddressCL Permission is hereby granted to dispose of the human remade ri d abepe 'ndicat Date Issued 08/02/2011 Registrar of Vital Statistics t (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 II"3`i( Place of Disposition 21.40144 Cr— (address) CC (section) 1(lot numbe (grave number) ▪ Name of Sexton or Per n in Charge Premises L h r>> e s.+K!{ (please print) 9 Si nature / Title C7E")ATU(L (over) DOH-1555 (02/2004)