Marcotte, George •
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
George A. Marcotte Male
Date of Death Age If Veteran of U.S. Armed Forces,
02/05/2013 91 years War or Dates 1942-46
.1 Place of Death Hospital, Institution or
City, T XOQ)pr�X Saratoga Springs Street Address Saratoga Hospital
lijci Manner of Death 0 Natural Cause 0 Accident 0 Homicide El Suicide 0 Undetermined ri Pending
tit Circumstances Investigation
ul Medical Certifier Name Title
Barry W. Mitchell M. D.
Address
211 Church St Saratoga Springs N Y 12866
Death Certificate Filed District Number Register Number
City, 1)401 110000 Saratoga Springs 4501 72
Burial I Date Cemetery or Crematory
02/08/2013 • Pineview Crematorium
❑Entombment Address •
]Cremation Queensbury N Y .
Date Place Removed
Z FiRemoval and/or Held
9 and/or Address
t Hold
t
C? Date Point of
• Q Transportation Shipment
O by Common Destination
Carrier •
Q 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
2 Address
to
Permission is hereby granted to dispose of the human remai scri ed above as indicated.
Date Issued 02/06/2013 Registrar of Vital Statistics - 17:4-,„AA
(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:
k 2.404.44
ut Date of Disposition '�'lt L3 Place of Disposition Cr4-1 0reti*-
(address)
iii
iX (section) of number) (grave number)
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ci
Name of Sexton or Person in Ch ge of Premises At•r Jt,n,4{'
/ (pleas print)
141 Signature l Title cizt ogoa
(over)
DOH-1555 (02/2004)