Hamlin, Richard NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
2.:!!! Name First Middle Last Sex
Richard M. Hamlin Male
Date of Death Age If Veteran of U.S. Armed Forces,
05/23/2015 60 years War or Dates 1973-90
Place of Death Hospital, Institution or
City, Tomen wx xX Saratoga S rin s Street Address
Manner of Death � 0 Sarato a Hos ital
[J,Natural Cause Accident ❑Homicide ❑Suicide 11 Undetermined ❑Pending
0
111 Circumstances Investigation
Ili Medical Certifier Name Title
L1 Susan Hayes- Masa Coroner
Address
40 McMaston St, Ballston Spa, NY 12020
Death Certificate Filed District Number Register Number
City, Tam YQX Saratoga Springs 4501 261
['Burial Date Cemetery or Crematory
ii: ❑Entombment 05/27/2015 Pineview Crematorium
Address
Ei [ +Cremation Queensbury N Y
Date Place Removed
❑Removal and/or Held
and/or Address
ht Hold
tO
0 Date Point of
Di0 Transportation Shipment
a by Common Destination
gi Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Ri
Permit Issued to Registration Number
ini Name of Funeral Home Densmore Funeral Home O044R
Ei Address
7 Sherman Ave, Corinth, New York 12822
111 Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
;; Address
02
itif
CL
Permission is hereby granted to dispose of the human remai es iby abo dicated
DI Date Issued 05/26/2015 Registrar of Vital Statistics ��
(signature)
Ni 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:
Ili Date1 r Date of Disposition 61 2i(/r Place of Disposition ,..✓
2 (address)
LE[
CO
I (section) /e (lot number) (grave number)
Name of Sexton or Perso in Charge of Premises (//'[`r= S�'^ '
* (please print)
Signature -' Title ta*
(over)
DOH-1555 (02/2004)