Sinksen, Dorothy NEW YORK STATE DEPARTMENT OF HEALTH It lot
Vital Records Section t , ,_ Burial - Transit Permit
Name First Middle Last Sex
Dorothy F. Sinksen Female
Date of Death Age If Veteran of U.S. Armed Forces,
12/29/2012 87 years War or Dates
t- Place of Death Hospital, Institution or
CityILI , T� orXil Saratoga Springs Street Address Wesley Health Care Center
0 Manner of Death w Natural Cause 0 Accident 0 Homicide 0 Suicide 0 Undetermined 0 Pending
tii Circumstances Investigation
at Medical Certifier Name Title
fl Colleen Oiiinn M fl
Address
131 Lawrence St., Saratoga Springs, N Y
Death Certificate Filed District Number Register Number
City, WAlkigiiik4ac Saratoga Springs 4501 584
UBurial Date Cemetery or Crematory
,�EnteR+lrment 12/31/2012 Pineview Crematorium
Address
,QCremation Queensbury N Y
Date Place Removed
Z n Removal and/or Held
2 and/or Address
N Hold
U
0 Date Point of
toai❑Transportation Shipment
0 by Common Destination
Carrier
Disinterment Date Cemetery Address
Q 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
Z Address
IX
l
` Permission is hereby granted to dispose of the human rema. cri d at e indicat .
Date Issued 12/31/2012 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:
tilu Date of Disposition I.4-13 Place of Disposition 'f i�r tJ`t.l (7,:e �Orf,�..
(address)
ILI
W.
M (section) (lot number) S ii (grave number)
Name of Sexton or Person in Charge of Premises 1.. �- t a'�1
z ease print)
gi
Signature41 Title C-c hiTi,
(over)
DOH-1555 (02/2004)