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Rosser-Tooker, Julie A.
11 �3 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Julie A Rosser-Tooker Female Date of Death Age If Veteran of U.S.Armed Forces, 10/25/2020 62 Years War or Dates F Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital p Manner of Death ©Natural Cause Accident El Homicide Suicide Undetermined El Pending VCircumstances Investigation ILI Medical Certifier Name Title CI Numan Rashid MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 551 ElBurial Date Cemetery,Crematory or Facility Name 10/31/2020 Pineview Crematory El Entombment Address lCremation Queensbury Town,New York Donation Removal Date Place Removed and/or and/or Held F Hold Address 0 CL U) ❑Transportation Date Point of Er) by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 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 CC uJ EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/28/2020 Registrar of Vital Statistics John Paul Franck(Electronically Signed) (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: H Z Date of Disposition 1113 00 Place of Disposition 2 (a dress) W CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Pre ises 1ts/pe prin W Signature `, Title 014 -11 DOH-1555(o7/t8)pi of 2 i .r• - I Public Health Law Sec. 4145(2b) )14165 Receipt - - , Human remains of . , . delivered on , 20 ., . .__ Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# .' '