Murphy, Judith I It
NEW YORK STATE DEPARTMENT OF HEALTH . - # lal
Vital Records Section Burial - Transit Permit
i Name First Middle Last Sex
Judith Rae Murphy Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/23/2014 76 years_ War or Dates
Place of Death Hospital, Institution or
City, TcXX X\AUCKIXX Saratoga Springs Street Address Weslev Health Care Center
Manner of Death ,Natural Cause El Accident El Homicide Li Suicide Undetermined ❑Pending
iti
Circumstances Investigation
W Medical Certifier Name Title
Rick D. Teetz M. D.
Address
131 Lawrence Street, Saratoga Springs N Y
Death Certificate Filed District Number Register Number
>i City, Td (' Di X Saratoga Springs 4501 100
❑Burial Date Cemetery or Crematory
❑Entombment 02/25/2014 Pineview Crematorium
Address
[, Cremation Queensbury N Y
Date Place Removed
Z❑Removal and/or Held
2 and/or Address
Fr Hold
Date Point of
tl
Transportation Shipment
0 by Common Destination
lip Carrier
Q Disinterment Date Cemetery Address
0 Reinterment Date Cemetery Address
giiiIN 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
Address
11
ICE!
Permission is hereby granted to dispose of the human rem " s de ;trcy.11 aide a indicat
`' Date Issued 02/25/2014 Registrar of Vital Statistics _ i
(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:
til Date of Disposition 1-l14 Place of Disposition ,oetra,j C.f wrlor++^—
(address)
w
c
te (section) lot number)/ (grave number)
CName of Sexton or Person in arge of Premises
Z (please print)
l ! Signature 44.-- 4 Title + ''` CL_
(over)
DOH-1555 (02/2004)