Hopkins, Esther NEW YORK STATE DEPARTMENT OF HEALTH t 7" 6
Vital Records Section Burial - Transit Permit
_ Name First Middle Last Sex
Esther M. Hopkins Female
Date of Death Age If Veteran of U.S. Armed Forces,
05/01/2013 84 years War or Dates
.1 Place of Death Hospital, Institution or
W City, TOVTAX04NROgt Saratoga Springs Street Address Wesley Health Care Center
Manner of Death®Natural Cause 0 Accident 0 Homicide Suicide 0 Undetermined Pending
W. Circumstances Investigation
43
ul 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, TCXXX0900fte Saratoga Springs 4501 198
0Burial Date Cemetery or Crematory
❑Entombment 05/02/2013 I Pineview Crematorium
Address
'<:',[]Cremation Queensbury N Y
Date Place Removed
Z❑Removal and/or Held
F and/or Address
Hold
0 Date Point of
Q Transportation Shipment
a by Common Destination •
Carrier
Q Disinterment Date • Cemetery Address .
❑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
Ili
Permission is hereby granted to dispose of the human remai s described ove s indic d.
Date Issued 05/01/2013 Registrar of Vital Statistics I -I
(signature)
li 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 (� (�
W Date of Disposition Z-($ Place of Disposition 'T t(.eV6,J �rorc0f1--
(address)
w
W
re (section) (lot number (grave number)
CI Name of Sexton or Person in Charge of Premises oo , tiv-/
it-
2 kili(please print)
Signature dilTitle C .01".
(over)
DOH-1555 (02/2004)