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Waldron, Jacqueline ft NEW YORK STATE DEPARTMENT OF HEALTI4 .� egi Vital Records Section Burial - Transit Permit Name Firs Jacqueline MiddleJ. aldron Sex Female Date of Death Age If Veteran of U.S. Armed Forces, 02/03/2014 50 years War or Dates }- Place of Death Hospital, Institution or W City, T?f X r*� Saratoga Springs Street Address Saratoga Hospital 0 Manner of Death®Natural Cause 0 Accident El Homicide El Suicide 0 Undetermined Pending IliCircumstances Investigation ta Medical Certifier Name Title 0 Rodney Ying MD Atyrtle Street Saratoga Springs, Ny Death Certificate Filed District Number Register Number City, Tgr Saratoga Springs 4501 54 0Burial Date Cemetery or Crematory 02/05/2014 Pineview Crematory 0Entombment Address ©Cremation Queensbury, N Y Date Place Removed ZRemoval and/or Held and/or Address li Hold 0 Date Point of 05 ❑Transportation Shipment d by Common Destination Carrier Disinterment Date Cemetery Address Q 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 ;s Address Ir UI �` Permission is hereby granted to dispose of the human remaitf de ri d Ware indicate . Date Issued 02/04/2014 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: 2 tkl Date of Disposition j f$'ry Place of Disposition Zvi Oft v Cst4ari— (address) IJJ. 0/? CC (section) i (lot number) (grave number) Ci Name of Sexton or Pers in Charge f Premises r.r , Jc 2please print) Si 9 nature y4.- Title Cialhlrt ft, (over) DOH-1555 (02/2004)