Morris, Margaret NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last ex
Margaret E. Morris emale
Date of Death 12-26-2012 Age 78 If Veteran of U.S. Armed Forces,
War or Dates N/A
{- Place of Death Hospital, Institution or
Z W Village Ballston Spa Street Address Maplewood Manor
0 Manner of Death ONatural Cause 0 Accident 0 Homicide 0 Suicide ElUndetermined ri Pending
Circumstances Investigation
.0 Medical Certifier Name Title
Q Leonard Gelman MD
Address
20 Prospect Street, Ballston Spa, New York 12020
Death Certificate Filed District Number Register Number
q6650Tmennyillage Ballston Spa 4520 100
❑Burial Date Cemeter�qr Cremator
12-27-2012 Pinebiew Crematory
❑Entombment
Address
tremati& Oueensbury, New York
Date Place Removed
Z❑Removal and/or Held
C3 and/orF•i Address
I Hold
6 Date Point of
ilk Q Transportation Shipment
G . 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 Avenue, Corinth, New York 12822
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Cr
Ili •
ec
"" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12-27-2012 Registrar of Vital Statistics cs.i1 X 64., 1-- y,
(signa0
District Number 4520 Place Village of Ballston Spa
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z �
l Date of Disposition ILr31-tl. Place of Disposition -'' t(kw Corttor,o-
(address)
in
to
rr (section) ` (lot number) (grave number)
DName of Sexton or Perso in Charge of remises t,> �,.._ f!�A1
z (pease print)
ILI
Signature Title C 124fhi{1-cv,Z
(over)
DOH-1555 (02/2004)