Duffney, Donald NEW YORK STATE DEPARTMENT OF HEALTH4 •1 VI.
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Donald G. Duffney Male
Date of Death Age If Veteran of U.S. Armed Forces,
09/15/2011 40 years War or Dates
E.- Place of Death Hospital, Institution or
W City, litleitgriebn Saratoga rings Street Address Saratoga Hospital
W Manner of Death Natural Cause fl Accident ❑Homicide ❑Suicide El Undetermined ❑Pending
Circumstances Investigation
Ili Medical Certifier Name Title
Q George Siniapkin M D
Address
604 Palmer Avenue, Corinth, N Y 12822
Death Certificate Filed District Number Register Number
City, TgtVICAr j(j flXg Saratoga Spiv 4501 404
❑Burial Date Cemetery or Crematory
:0❑Entombment Address09/19/2011 Pineview Crematorium
[Cremation Queensbury N Y
Date Place Removed
Z❑Removal and/or Held
g and/or Address
E Hold
in
O Date Point of
❑Transportation Shipment
Et 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
Address
s
ILI
Permission is hereby granted to dispose of the human remai ri d abp& -ndicate
Date Issued 09/16/2011 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:
Z
Ili Date of Disposition q llh hi Place of Disposition 'PMt kl Crr ors
2 (address)
Cl)ILI
CC (section) (lot number (grave number)
0
Name of Sexton or Person in Charge of Premises ajr4 r twill-'
Z (please print)
liaSignature AL /� Title CIS-hope
(over)
DOH-1555 (02/2004)