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Arcate, Claudia NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Claudia Arcate Female • Date of Death Age If Veteran of U.S.Armed Forces, 12/19/2020 84 Years War or Dates i_ Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death ©Natural Cause Accident ❑Homicide ❑Suicide ❑Undetermined Pending W Circumstances Investigation CI Medical Certifier Name Title Julian Marynczak PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 583 0 Burial Date Cemetery,Crematory or Facility Name 12/21/2020 Pineview Crematory Entombment Address 0 Cremation Queensbury Town,New York Donation 0 Removal Date Place Removed and/or and/or Held N Hold Address O 0- Date Point of (/) Li 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 f,. Remains are Shipped,If Other than Above 2 Address CC LU O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/21/2020 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IF— W Date of Disposition /2-2/-207a Place of Disposition P/hc 't) ) (addZss) W N CC (sea%on) / (lot number) (grave number) Name of Sexton or Per in Charge of Premises J r.. l/ ✓! 64414/�' W1 (please print) Signature Title GfP�'ky DOH-1555(07/18) i of 2 Public Health Law Sec. 4145(2b) ' ' 014 3 l 7 Receipt Human remains of delivered on , 20 Pine View Cemetery Reprt tinting the funeral home named on burial permit Official Funeral Directors Reg.or License#