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Grant, Wilber 4 tS7 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Wilber E.Granti'S Male Date of Death Age If Veteran of U.S.Armed Forces, '.; 08/09/2018 78 Years War or Dates n Place of Death Hospital, Institution or _ City, Town or Village Saratoga Springs Street Address Saratoga Hospital s Manner of Death©Natural Cause ❑Accident El Homicide El Suicide ❑Undetermined ❑Pending , i Circumstances Investigation -- Medical Certifier Name Title Derek Smith MD Address ' 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number r . City, Town or Village Saratoga Springs 4501 445 ❑Burial Date Cemetery or Crematory 770 08/10/2018 Pineview Crematorium ": ;Li Entombment Address ma®Cremation Queensbury Town, New York 4.5 Date Place Removed ❑Removal and/or Held ' and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier ilii ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address 47 , = Permit Issued to Registration Number Pti Name of Funeral Home Densmore Funeral Home Inc 00448 ob tix 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 a: , Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/10/2018 Registrar of Vital Statistics 2ohn Eranck(�ElectronicallySigned) (signature) District Number 4501 Place Saratoga Springs, New York Sl A' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: t`-R Date of Disposition i(t3Nig Place of Disposition f?,U ,,, !', (address) w- (section) (lotriper) c (grave number) —t Name of Sexton or Person in Charge of Premises Actet ,JQ4U1 (please!stint) t gPSignature Title i'T M/L (over) DOH-1555 (02/2004)