Whiting, Darlene NEW YORK STATE DEPARTMENT OF HEALTH �� # 2(if—
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Darlene E. Whiting Female
Date of Death Age If Veteran of U.S. Armed Forces,
03/31/2015 80 years War or Dates
Place of Death Hospital, Institution or
ifj City, Toy(xxXViJXXXx Saratoga Springs Street Address Wesley Health Care Center
ci Manner of Death atural Cause illAccident ElHomicide ❑Suicide ❑Undetermined ❑Pending
in Circumstances Investigation
uil Medical Certifier Name Title
Q Edit Masaba MD
Address
35 Gilbert St., Cambridge, N Y 12816
Death Certificate Filed District Number Register Number
City, ToxxxxVjOutxx Saratoga Springs 4501 163
❑Burial Date Cemetery or Crematory
❑Entombment 04/01/2015 Pineview Crematory
Address
❑,cremation Queensbury, N Y
Date Place Removed
rZ` El❑Removal and/or Held
and/or Address
—, Hold
Cl)
0 Date Point of
5❑Transportation Shipment
63 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
2.
ill
�' Permission is hereby granted to dispose of the human remains-des ib ab ' dicate
Date Issued 04/01/2015 Registrar of Vital Statistics
(signature)
District Number 4501 Place Saratoga Springs
1 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
lil Date of Disposition IN Place of Disposition ZUt,..
2 (address)
U
CC (section) it (lot number (grave number)
aiel
Name of Sexton or Pers n in Charge of Premises .,;kr� w' —
i« (phase print)
Ili Signature �' `^ Title � �' �
9
(over)
DOH-1555 (02/2004)