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Richards, Kara M
- i NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permi Bureau of Vital Records Name First Middle Last Sex Kara M Richards Female Date of Death Agee If Veteran of U.S.Armed Forces, 11/12/2020 -.36 ears War or Dates Place of Death Hospital,Institution or Z City,Town or Village Waterford Town Street Address 19 Ferguson Lane,Waterford Town,New York 12188 W Manner of Death Undetermined Pending W Natural Cause Accident 1=1Homicide Suicide © Circumstances Investigation W Medical Certifier Name Title Robert Ball Coroner Address 10 Glen Eagles Blvd,Ballston Lake,New York 12019 Death Certificate Filed District Number Register Number City,Town or Village Waterford 4568 20 ElBurial Date Cemetery,Crematory or Facility Name 11/16/2020 Pineview Crematory ElEntombment Address 0 Cremation Queensbury Town,New York ElDonation Removal Date Place Removed and/or and/or Held — Hold Address 0 Date Point of to �Transportation p by Common Shipment Carrier Destination Disinterment 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 1— Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/16/2020 Registrar of Vital Statistics Mary Shannon Carrigan(Electronically Signed) (signature) District Number 4568 Place Waterford, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition it'Hp PO Place of Disposition 2 (address) W CC (section) (lot number) (grate number) �- g Name of Sexton or Person in Charge of remises 4641- -53,vvi silr z (pl se print) W tICilitf Signature Title ` DOH-1555(o7/18)p t of 2 Public Health Law Sec. 4145(2b) 1 /12 f l Receipt Human remains of `, delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# 9'