Lee, Jeanne r
y ,
NEW YORK STATE DEPARTMENT OF HEALTH ki
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Jeanne B.Lee ,,&. Female
Date of Death Age If Veteran of U.S. Armed Forces,
01/11/2018 85 Years War or Dates
Place of Death Hospital, Institution or
j City, Town or Village Saratoga Springs Street Address Saratoga Hospital
rttl Manner of Death Airal Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
i $ Medical Certifier Name Title
411 Bert Pyle MD
Address
F'', 211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 21
=:❑Burial Date Cemetery or Crematory
01/12/2018 Pineview Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
4❑Removal and/or Held
and/or Address
07ii Hold
: Date Point of
,K❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
,,F Permit Issued to Registration Number
," Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
IX Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
t Address
'rajI
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/12/2018 Registrar of Vital Statistics John P Franck(ECectronica1TySigned)
(signature)
District Number 4501 Place
Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I Date of Disposition / z Place of Disposition h n v i i / L-r'C -47
-s
t (address)
(section) (lot num er) (grave number)
il
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remises Title 6 f Q :,,-1.-.„t'iv --
(over)
DOH-1555 (02/2004)