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Izzo, Patricia NEW YORK STATE DEPARTMENT OF HEALTH # I I 1 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Patricia F. Izzo Female Date of Death Age If Veteran of U.S. Armed Forces, 02/27/2012 63 years War or Dates j— Place of Death Hospital, Institution or City, TXXXXI-MCXX Saratoga Springs Street Address Saratoga Hospital a Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending ILICircumstances Investigation W Medical Certifier Name Title 0 Rodney Ying MD Address 59 Myrtle Street Saratoga Springs, Ny Death Certificate Filed District Number Register Number City, T XXrX J Saratoga Springs 4501 86 ['Burial Date Cemetery or Crematory ❑Entombment 02/29/2012 Pineview Crematorium Address : OCremation Queensbury N Y • Date Place Removed Removal and/or Held and/or Address F:: Hold O Date Point of p" Transportation Shipment in by Common Destination Carrier Disinterment Date Cemetery Address 0, 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 Remains are Shipped, If Other than Above Address i lid - PI Permission is hereby granted to dispose of the human rem is de MIatf+�r ind aicat Date Issued 02/29/2012 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: to Date of Disposition 6.4 (ttotj Place of Disposition ' tUcP3 CA-Nei dr[0+-- a (address) tii CC (section) 4.ykipii,(lot number)c- (grave number) Name of Sexton or Pers n Charge •f Premises 5,-i2in ! (please print) Signature l„ Title C(# i it, (over) DOH-1555 (02/2004)