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Howe, Calvin NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Calvin G . Howe Male Date of Death Age If Veteran of U.S. Armed Forces, 04/02/2015 64 War or Dates 1- Place of Death Hospital, Institution or 111 City, Town or Village Town of Hadley Street Address Stony Creek Road 0 Manner of Death❑Natural Cause ©Accident Homicide El Suicide riUndetermined 0 Pending tt1 Circumstances Investigation W Medical Certifier Name Title G N. Balasubramania MD Address Church St. , Saratoga Sp. , NY 12866 Death Certificate Filed District Number _ Register Number ^ City, Town or Village Town of Hadley 4 5 S% S ❑Burial Date Cemetery or Crematory 04/06/2015 Pineview Crematory ::.❑Entombment Address ®Cremation Queensbury, NY Date Place Removed ❑Removal and/or Held r and/Holdor Address = 0 Date Point of ❑Transportation Shipment C by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home , Inc. 00448 Address 7 Sherman Ave . , Corinth , NY 12822 Name of Funeral Firm Making Disposition or to Whom ▪ Remains are Shipped, If Other than Above • Address ix fI f! Permission is hereby granted to dispose of the human remains described above as indicate Date Issued 0 4/0 3/2 015 Registrar of Vital Statistics 6 � �. (" (signature) District Number is_5---5-g7 Place u l I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: k fLL.J Ill Date of Disposition ti(,�((�' Place of Disposition Ci�°}c ¢- 2 (address) la ta CC (section) (lot number) (grave number) Ci Name of Sexton or Person in Charge of Premises //`-i, t- S't 4 (p ase pant) Iiit Signature (�" Title attko f{",K. (over) DOH-1555 (02/2004)