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Henry, Dorothy NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Dorothy J.Henry Female Date of Death Age If Veteran of U.S.Armed Forces, 02/10/2018 97 Years War or Dates W.W.II Place of Death Hospital, Institution or City, Town or Village Saratoga Springs Street Address Saratoga Hospital Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Stephen Offord MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City, Town or Village Saratoga Springs 4501 93 ❑Burial Date Cemetery or Crematory 02/13/2018 Pine View Crematory El Entombment Address ®Cremation Queensbury, New York Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of - ❑Transportation Shipment by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Wilcox&Regan 01821 Address 11 Algonkin St,Ticonderoga,New York 12883 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/10/2018 Registrar of Vital Statistics John P'Franck(ECectronicallySigned) (fie) - 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: • Date of Disposition /i4 0)(3 r Place of Disposition p;Aq, 1/A4j (.,rt"arii I (address) (section) (lot number) (grave number) - Name of Sexton or Person in Charge of Premises .1trr.,e.y Sej,k,; S } { (please print) Signature #42-11e-'�t� Title 'rL '[L cf (over) DOH-1555(02/2004)