Duguay, Laura ��-t-
NEW YORK STATE DEPARTMENT OF HEALTH. �7f
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Laura J. Duguay Female
Date of Death Age If Veteran of U.S. Armed Forces,
06/27/2015 85 years War or Dates
F- Place of Death Hospital, Institution or
5 City, TWAIRr j(J Saratoga Springs Street Address Wesley Health Care Ctr
W Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ri❑Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
a Diane Westbrook N P
Address
131 Lawrence Street, Saratoga Springs, N Y
Death Certificate Filed District Number Register Number
City, TWXTX fr X I n Saratoga Springs 4501 315
❑Burial Date Cemetery or Crematory
"'Entombment Pineview Crematory
Address
ECremation Queensbury, N Y
Date Place Removed
Z r—i❑Removal and/or Held
and/or Address
H Hold
0
O Date Point of
0❑Transportation Shipment
a by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑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
W
d` Permission is hereby granted to dispose of the human rema'`s des ri d abore indicate .
Date Issued 06/29/2015 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:
r
tu Date of Disposition 6-30_ i j Place of Disposition °nt u,""t,� Ctema.-Lf4'ivy
2 (address)
lti!
CO
l (section) (lot number) (grave number)
e
0 Name of Sexton or Person in Ch ge of Premises t I meth,( fVna'C
z � / (please print)
r
Lt Signature c,+ ►i-t,4 1j�• Title ticiii 4.{ 134-1-•
(over)
DOH-1555 (02/2004)