Totten Jr, Joseph •
NEW YORK STATE DEPARTMENT OF HEALTH X. •
. Vital Records Section Burial - Transit Pe it
Name First _ Middle Last Sex
Joseph E. Totten Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
05/21/2013 74 years War or Dates
Place of Death Hospital, Institution or
City, Tx,x�pr Q qx Saratoga Springs Street Address Wesley health Care Center
Manner of Death Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
til Circumstances Investigation
tu Medical Certifier Name Title
0 Austin Tsai M D
Address
131 Lawrence St., Saratoga Springs, N Y
Death Certificate Filed District Number Register Number
City, 1)QXl%Qr) JQ 4X Saratoga Springs 4501 230
gi 0 Burial Date Cemetery or Crematory
05/28/2013 Pineview Crematorium
❑Entombment Address
gol Cremation Queensbury N Y .
Date Place Removed
Z ri Removal and/or Held
2 and/or
F Hold Address
SA
0 Date Point of
CL o) Transportation ' Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
ii,i ❑Reinterment Date Cemetery Address
II Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home - 00448
niii Address
7 Sherman Ave, Corinth, New York 12822
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
I
CU Permission is hereby granted to dispose of the human remain _ ib abor a ' dicated
Date Issued 05/23/2013 Registrar of Vital Statistics
(signature)
District Number 4501 Place Saratoga Springs
giii
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
litDate of Disposition 5131 113 Place of Disposition 4DLhlJ rw-K c;.),,..
2' (address)
11
0
IC (section) (lot umber) C (grave number)
ti Name of Sexton or Perso in Charge of Pr mises 6 '''t o — 844-
Z (p ase print)
Signature st, _ Title ativliciTOtt_
(over)
DOH-1555 (02/2004)