Marcotte, Sherry A. •
NEWYORKSTATEDEPARTMENTOFHEALTH i
Bureau of Vital Records Burial Transit Permit
Name First Middle Last Sex
Sherry A Marcotte Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/24/2020 60 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Corinth Town Street Address 151 Miner Rd,Corinth Town, New York 12822
pManner of Death 0 Natural Cause 0 Accident 0 Homicide 0 Suicide El Undetermined 0 Pending
U Circumstances Investigation
W Medical Certifier Name Title
Carlos Ares MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Corinth 4553 31
❑Burial Date Cemetery,Crematory or Facility Name
11/25/2020 Pineview Crematory
Entombment Address
gCremation Queensbury Town,New York
❑Donation
Removal Date Place Removed
and/or and/or Held
F- Hold Address
(/)
0
n. Date Point of
CO ❑Transportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
Disinterment
❑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
i- Remains are Shipped,If Other than Above
Address
fZ
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/25/2020 Registrar of Vital Statistics Wrenia L Pen's gkctronicall:y Signed)
(signature)
District Number 4553 Place Corinth, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this per n:
Z▪ Date of Disposition la(17 IN Place of Disposition
2 (address)
W
Cr
(section) (lot number) c (grave number)
O gVL'
Name of Sexton or Person inCharge f Premises r��
O (pl ase print) `
Z (j12 '�tn✓J 1
W Signature Title ��l"�`
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) I ?
Receipt
Human remains of delivered on , 20
Pine View Cemetery Repwsertting the funeral home named on burial permit
Official Funeral Directors Reg.or License#