Drayton, Joanne # ,° INEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
JoanneDrayton Female
Date of Death Age If Veteran of U.S. Armed Forces,
11/11/2014 77 years War or Dates
.}- Place of Death Hospital, Institution or
mown or ( Greenfield Street Address 16 Plank Road, Lot 35
141
• Manner of Death ,Natural Cause ❑Accident ❑Homicide ElSuicide ❑Undetermined ❑Pending
Circumstances Investigation
iii Medical Certifier Name Title
Harold G. Card, Jr M D
Address
6 Care Lane, Saratogs Springs, N Y 12866
Death Certificate Filed District Number Register Number
4(XKXown or veraga Greenfield 4557 22
❑Burial Date Cemetery or Crematory
11/12/2014 Pineview Crematorium
II Entombment Address
[ Cremation Queensbury, N Y
Date Place Removed
❑Removal and/or Held
i="` Hold
and/or Address
ta
Date Point of
IL ri
co Li 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 Avenue, Corinth, New York 12822
Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
• Address
it
Lu
Permission is hereby granted to dispose of the human remaips descri above as Ind'' ated.
Date Issued 11/12/2014 Registrar of Vital Statistics ,u, , , �c I ,� 2 ti
`' (signature) d
District Number 4557 Place Greenfield
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k
ta Date of Disposition it/t31 iy Place of Disposition ;i,,,, v,,,,, 6 f"--
(address)
Ili
CC (section) jot number) (grave number)
aName of Sexton or Person i Charge of Premises 4 41.
2 (pie se print)
ta Signature Ir - / Title 'P.XMtr}F8it
(over)
DOH-1555 (02/2004)