Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
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)