Foster, Kathryn 0/3
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last ' Sex
Kathryn G. Foster Female
Date of Death Age If Veteran of U.S. Armed Forces,
10/19/2015 82 years War or Dates
Place of Death Hospital, Institution or
/LIZ City, T Street Address
9 'X9f X Saratofy-S ing� Sarato a Hospital
Manner of Death❑'Natural Cause Accident ❑Homicide 0 Suicide Undetermined D Pending
it$ Circumstances Investigation
W Medical Certifier Name Title
.4 Mark Weidner M D
Address
211 Church Street, Saratoga Springs, N Y 12866
Death Certificate Filed District Number Register Number
City, Tc y1 g(* X Saratoga Springs 4501 4R7
. ❑Burial Date Cemetery or Crematory
❑Entombment 10/21/2015 Pineview Crematory
Address
[Cremation Queensbury, N Y
Date Place Removed
Z n Removal and/or Held
and/or Address
fiI)
Hold
Date Point of
tip ❑
EL Transportation Shipment
a by Common Destination
Carrier
El 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
i Name of Funeral Firm Making Disposition or to Whom
I,.: Remains are Shipped, If Other than Above
2 Address
IX
l
." Permission is hereby granted to dispose of the human remain escr =over y icated.
Date Issued 10/21/2015 Registrar of Vital Statistics
(signature)
District Number 4501 Place Saratoga Springs
IH I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z ,,
JW fig1/Date of Disposition joittfir Place of Disposition _, 1, --
W (address)
W
CC (section) / -(lot number) (grave number)
pName of Sexton or Person in Charge of Premises ` ��� L �U"`t
Z: d .6--- (please print),��
I I Signature Title � /f' •r
(over)
DOH-1555 (02/2004)