Gregoire, Joanne r • ' ilil
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
. Name First Middle Last Sex
• Joanne Ruth Gregoire Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/12/2018 70 Years War or Dates _
Place of Death Hospital, Institution or
City, Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre
Manner of Death®Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
4
Medical Certifier Name Title
�yt ,
Suzanne Blood MD
• Address
152 Sherman Ave,Queensbury Town,New York 12801
r=' Death Certificate Filed District Number Register Number
City, Town or Village Queensbury 5657 38
Xty❑Burial Date Cemetery or Crematory
03/14/2018 Pine View Crematorium
❑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
,k6❑Disinterment Date Cemetery Address
• ❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
;_:? Name of Funeral Home Densmore Funeral Home Inc 00448
Address
4 7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
F,$ Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/14/2018 Registrar of Vital Statistics Caroline EBarber(EfectronicaltySigned)
(signature)
District Number 5657 Place Queensbury, New York
{
xn, I certify that the remains of the decedent identified above were disposed of in accordance� with this permit on:
Date of Disposition 3/I IIS Place of Disposition R„U I,/.K,t.,,
(address)
IT
= (section) 4 (lot num (grave number)
.' Name of Sexton or Person in Charge f Premises [b. „it."" (tease nt)
Signature Title liki t,
(over)
DOH-1555 (02/2004)