Jeremias, Deborah i 1 4re
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Deborah L. Jeremias Female
Date of Death Age If Veteran of U.S. Armed Forces,
02/08/2014 54 years War or Dates
I-- Place of Death Hospital, Institution or
Z City, T r(&"UM Saratoga Springs Street Address Saratoga Hospital
IliManner of Death R Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
ILI Circumstances Investigation
tu Medical Certifier Name Title
CI Stephen Offord Md
Ad2111suhurch Street, Saratoga Springs, Ny 12866
Death Certificate Filed District Number Register Number
City, T ISr W Saratoga Springs 4501 68
❑Burial Date Cemetery or Crematory
02/12/2014 Pineview Crematory
['Entombment Address
ECremation Queensbury, N Y
Date Place Removed
❑Removal and/or Held
2and/or Address
F= Hold
IA
O Date Point of
s Transportation Shipment
O 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
1 Remains are Shipped, If Other than Above
• Address
ilk
W
tt Permission is hereby granted to dispose of the human remains described above as indicate .
Date Issued 02/10/2014 Registrar of Vital Statistics l ---19
.
(signature)
i
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:
pp
I Date of Disposition i Place of Disposition ;ti,1 C r..._
2 (address)
Ui Il3 JIN
Ul
IC (section) J (lot number) r (grave number)
• Name of Sexton or Person i Charge Premises / r k ,) -
2► (4ease print)
Signature Title 6
(over)
DOH-1555 (02/2004)