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Burdick, Kenneth E d Ig3 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kenneth E Burdick Male Date of Death Age If Veteran of U.S.Armed Forces, 02/14/2021 68 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Corinth Town Street Address 108 Comstock Road,Corinth Town,New York 12822 'p Manner of Death ©Natural Cause El Accident ❑Homicide El Suicide Undetermined El Pending U Circumstances Investigation W Medical Certifier Name Title CI John Mongan DO Address 3 Care Lane,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Corinth 4553 4 ElBurial Date Cemetery,Crematory or Facility Name 02/17/2021 Pineview Crematory ❑Entombment Address ]Cremation Queensbury Town,New York Donation Removal Date Place Removed and/or and/or Held ~ Hold Address 0 O. Date Point of CO ❑Transportation Shipment -es by Common Carrier Destination El 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 g Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/16/2021 Registrar of Vital Statistics Brenda L Peris(Electronically 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 permit on: WDate of Disposition 71 II 12I Place of Disposition 2 (address) W CC (section) if number/ (grave number) 0 Name of Sexton or Person in Cha f Premises Na'r 3s'"`"4 (please rint) W Signature Title Cbt711-v tz DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 1 4 5 5 C Receipt • Human remains of delivered on - , 20 Pine View Cemetery Repfesenting the funeral home named on burial permit Official Funeral Directors Reg.or License#