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Doody, Frances NEW YORK STATE DEPARTMENT OF HEALTH �S Vital Records Section Burial - Transit Permit Name Fiances Middle, Doody Seale Date of Death Age If Veteran of U.S. Armed Forces, 03/05/2014 90 years War or Dates .14 Place of Death Hospital, Institution or Z City, Xdl.41CoXlIQMX Saratoga Springs Street Address Saratoga Hospital Manner of Death©Natural Cause ['Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending til Circumstances Investigation W Medical Certifier Name Title Q. gAdydesha Sooriabalan M D 21;e iurch Street, Saratoga Springs, N Y 12866 Death Certificate Filed District Number Register Number City, 44i(oNnge Saratoga Springs 4501 118 ❑Burial Date Cemetery or Crematory 03/07/2014 Pineview Crematory ❑Entombment Address •U]Cremation Queensbury, N Y Date Place Removed ❑Removal and/or Held and/or Address I;;, tO Hold O Date Point of Transportation Shipment el by Common Destination Carrier ❑Disinterment Date Cemetery Address ii;iii❑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 iig Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 2 Address I U n"" Permission is hereby granted to dispose of the human remai cri d ab a indicate . Date Issued 03/06/2014 Registrar of Vital Statistics `—�, r' (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: p I Date of Disposition 3 J t I pi Place of Disposition 4 iL ac,OKi... 2 (address) Lu VI CC (section) tit y (lot number) (grave number) Name of Sexton or Person in Charge of Premises =S br (please print) ILI ig Signature d Title hA (over) DOH-1555 (02/2004) .