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Towers, Barbara 41 7co NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Barbara C. Towers Female Date of Death Age If Veteran of U.S. Armed Forces, 12/07/2013 84 years War or Dates Place of Death. Hospital, Institution or 1a City, T%XXQQ-XXXXX Saratoga Springs Street Address Saratoga Hospital a Manner of Death❑Natural Cause DAccident ❑Homicide ❑Suicide ❑Undetermined ❑Pending W Circumstances Investigation Ili Medical Certifier Name Title Suzanne Blood M D Address 161 Carey Road, Queensbury, NY Death Certificate Filed District Number Register Number City, TO )(Dtr XXX X Saratoga Springs 4501 509 ❑Burial Date Cemetery or Crematory 12/09/2013 Pineview Crematorium ❑Entombment Address ©Cremation Queensbury N Y Date Place Removed Z ❑Removal and/or Held 2and/or Address l=" Hold iv) O Date Point of CL Li Transportation Shipment • by Common Destination Carrier ❑Disinterment Date Cemetery Address • El 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 • Address IX Permission is hereby granted to dispose of the human remains 'be abovep dicated. Date Issued 12/09/2013 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: z UI Date of Disposition a-10-i3 Place of Disposition 2 (address) U) ifr (section) (lot number) (grave number) Ci Name of Sexton or Person in Charge of Premises (please print) Signature Title (over) DOH-1555 (02/2004)