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Gray, Estelle NEW YORK Si TE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Estelle T. Gray Female Date of Death Age If Veteran of U.S. Armed Forces, 12/17/2015 91 years War or Dates •}- Place of Death Hospital, Institution or • u.AZ City, Tom Street Address CRX Saratoga S rings Sara a Hospital Li Manner of DeathNatural Cause Accident ❑Homicide ❑Suicide Undetermined ❑Pending iii Circumstances Investigation til Medical Certifier Name Title CI Joshua.7_amer M D Address 211 Church Street, Saratoga Springs, N Y 12866 Death Certificate Filed District Number Register Number City, Town v( X Saratoga Springs 4fif1 606 ❑Burial Date Cemetery or Crematory • ❑Entombment 12/18/2015 Pineview Crematory Address ECremation Queensbury, N Y IZQj©/-/ Date Place Removed Z Removal and/or Held 4:p.:❑an Address t73 Holdd/or 0 Date Point of 0❑Transportation Shipment a by Common Destination Carrier ❑Disinterment Date Cemetery Address 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 2 Address tC IL Permission is hereby granted to dispose of the human remain desc b abo17fa i dicated. Date Issued 12/18/2015 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: Z !ti Date of Disposition/2.2/-/S Place of Disposition P72 e V,) C2a„/c1® 2 (addres ) W CA CC (section) (lot number) (grave number) pName of Sexton erso in Charge of Premises k1��✓t C e.,c.J2 (please print) iii. Signature Title Gr2rrkjei. l- (over) DOH-1555 (02/2004)