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Totten, Claire NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit • Name First Middle Last Sex Claire E. Totten Female • Date of Death Age If Veteran of U.S. Armed Forces, 07/13/2015 77 years War'or Dates 1— Place of Death Hospital, Institution or 6 City, 1-9VEKStr X*N ( Saratoga Springs Street Address Wesley Health Care Center W Manner of Death L Natural Cause 0 Accident ElHomicide IIISuicide ❑Undetermined ❑Pending U Circumstances Investigation l Medical Certifier Name Title C Rick D. Teetz M. D. Address 131 Lawrence Street, Saratoga Springs N Y Death Certificate Filed District Number Register Number City, T9Mom Xilintx Saratoaa Springs 4501 350 ['Burial Date Cemetery or Crematory ❑Entombment 07/17/2015 Pineview Crematory Address ©Cremation Queensbury, N Y Date s Place Removed z❑Removal and/or Held and/or Address H Hold 'I) o Date Point of N ❑Transportation Shipment G 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 Ave, Corinth, New York 12822 Name of Funeral Firm Making Disposition or to Whom fi. Remains are Shipped, If Other than Above ;Z Address w Permission is hereby granted to dispose of the human remain ibe abofs i dicated. Date Issued 07/15/2015 Registrar of Vital Statistics (signature) District Number 4501 Place Saratoga Springs ,- I certify that the remains of the decedent identified above were dispose f in accordance with this permit on: Z ILI Date of Disposition '7/solar Place of Disposition t,,.,V,.,, Crib---t*i, (address) t CC (section) (lot number) (grave number) Name of Sexton or Perso in Char of Premises �,,+ lease print l,Ailfi Z Signature Title $02 (over) DOH-1555 (02/2004)