Harvey, Muriel NEW YORK STATE DEPARTMENT OF HEALTH ` •1 7( /a 0
Vital Records Section Burial - Transit permit
Name First Middle Last Sex
Muriel E. Harvey F
Date of Death Age If Veteran of U.S. Armed Forces,
02/01 /201 6 86 War or Dates
14 Place of Death Hospital, Institution or
III City, Town or Village Greenfield Street Address 61 Alpine Meadows Road
a Manner of Death ❑Natural Cause ❑Accident El Homicide ❑Suicide ❑Undetermined ❑Pending
U.1 Circumstances Investigation4
W Medical Certifier Name Title
a
Vincent Meyer, MD
Address
418 Geyser Road, Ballston Spa, NY 12020
Death Certificate Filed District Number Register Number
City, Town or Village Greenfield 4557 3
El Burial Date Cemetery or Crematory
❑Entombment 02/02/2016 Pineview Cremation
Address
;❑Cremation.
i7ueensbury, NY
Date Place Removed
Removal and/or Held
9 and/or Address
t Hold
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0 Date Point of
es❑Transportation Shipment -
0 by Common Destination
Carrier •
Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home 00448
Address
7 SHerman Avenue, Corinth, NY 12822
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
0
is
CI` Permission is he eby granted to dispose of the human rema . 'describ , - -ove as indicated.
�� 1
Date Issued a- - l(o Registrar of Vital Statistics �_/`�" ; 0 A A . I �,A_ '
(signature)
District Number (fs
$7 Place 7 Cefrici.tilk
-,:,: I certify that the remains of the decedent identified above were di of in accordance with this permit on:
Z
til Date of Disposition;,--N-+t l Place of Disposition pint, V;t Cj'uriwetor\i
2 (adddffess)
tt
U)
IC (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises cl�.rrN2dY S' t;fer/5
++ (please print)
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Signature, : Title Gfe c 4c r
(over)
DOH-1555 (02/2004)