Marcotte, Kevin e93
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Kevin P. Marcotte Male
Date of Death Age If Veteran of U.S. Armed Forces,
17/12/2015 59 years War or Dates
i:.: Place of Death Hospital, Institution or
City, X�R�'1C��RX Saratoga
T Street Address •
° S
• Manner of Death❑,Natural Cause rings Accident El Homicide ❑Suicide Un etermined El Pending
W Circumstances Investigation
W Medical Certifier Name Title
Susan Hayes- Masa Coroner
Address
40 McMaston St, Ballston Spa, NY 12020
Death Certificate Filed District Number Register Number
City, To XX Saratoga Springs 4501 59A
❑Burial Date Cemetery or Crematory
['Entombment Pineview Crematory
Address
[cremation Queensbury. N Y /Zg0(.(
Date Place Removed
• Removal and/or Held
2 and/or Address
— Hold
tl
Q Date Point of
CL
❑Transportation Shipment
• by Common Destination •
Carrier
El 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
»'3emains are Shipped, If Other than Above
2 Address
IX
C` Permission is hereby granted to dispose of the human rem sc ' edv indica d.
Date Issued 12/15/2015 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:
�
W Date of Disposition /Z-/8-/ f Place of Disposition ' i vj etj ieinr 7
(address)
W
CC (section) (lot number) (grave number)
pName of Sexton Person in Charge of Premises to 1-gin lx �- e
(please print)
itl Signature Title e r�'i9'le._-/o
(over)
DOH-1555 (02/2004)