Cote, Windor NEW YORK STATE DEPARTMENT OF HEALTH 331
Vital Records Section t e 1 Burial - Transit Permit
Name First Middle Last Sex '
Windor G. Cote Male
Date of Death Age If Veteran of U.S. Armed Forces,
06/27/2011 98 years War or Dates
14 Place of Death Hospital, Institution or
5 City, T)Q)trX)prljXX Saratoga Springs Street Address Wesley Health Care Center
a Manner of Death 0 Natural Cause Ell Accident Diomicide El Suicide riUndetermined El Pending
LLt Circumstances Investigation
W Medical Certifier Name Title
44 Matthew C. Pender M D
Address
131 lawrence Street, Saratoga Springs, N Y
Death Certificate Filed District Number Register Number
City, -00006rXXX*0 Saratoga Springs 4501 293
< ['Burial Date Cemetery or Crematory
07/05/2011 Pineview Crematorium
['Entombment Address
®Cremation Queensbury N Y
Date Place Removed
Z Removal and/or Held
0❑and/or Address
H Hold
fit)
0 Date Point of
Transportation Shipment
a by Common Destination
gi Carrier
Q Disinterment Date Cemetery Address
El 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
fik Remains are Shipped, If Other than Above
2 Address
c
tU
` Permission is hereby granted to dispose of the human remai cri d ate a indicate .
Date Issued 06/30/2011 Registrar of Vital Statistics
(signature)
District Number 4501 Place Saratoga Springs
I .
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ILI Date of Disposition 1-(,-1( Place of Disposition '0 ►^'Vet.) CIIPM to3,,,—
(address)
Ui
tO
IX (section) G (lot nu er (grave number
p f ( `'��Name of Sexton or Per n in Charg f Premises . f' --����+ift- )
Z I (please pant)
tii Signature Title CCt CII�t
g
(over)
DOH-1555 (02/2004)