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Sycuro, Rosemarie NEW YORK STATE DEPARTMENT OF HEALTH 3 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Rosemarie A. Sycuro Female Date of Death Age If Veteran of U.S. Armed Forces, 10/27/2011 81 years War or Dates j-- Place of Death Hospital, Institution or City, TRittitkr Mt c Saratoga rings Street Address Saratoga Hospital W Manner of Death©Natural Cause Accident ❑Homicide ❑Suicide ❑Undetermined El Pending Circumstances Investigation W Medical Certifier Name Title O Heather Madigan M. a Address 211 Church Street, Saratoga Springs, N Y 12866 Death Certificate Filed District Number Register Number City, TXXXW jNUX Saratoga Springs 4501 455 ❑Burial Date - Cemetery or Crematory ❑Entombment 10/28/2011 • Pineview Crematorium Address Cremation Queensbury N Y Date Place Removed Z Removal and/or Held ❑and/or Address 1,7 Hold 3 Date Point of t n Transportation Shipment Cl by Common Destination Carrier ❑Disinterment Date Cemetery Address L 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 l,-• Remains are Shipped, If Other than Above '„ Address Illy il Permission is hereby granted to dispose of the human remain cribed above as indicated. iEN Date Issued 10/28/2011 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: 2 I ! Date of Disposition Nil 4 t Place of Disposition ei.-F(Lin) 0. ,-4-J'i,. 2 (address) 111 CC IC (section) j (lo umber) (grave number) ct Name of Sexton or P rson in Charg of Premises i »1 e ""'iii' Z / (please print) tJ _Zilf—Signature Title Cq 1=ir41.01j (over) DOH-1555 (02/2004)