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Lake, Yong I
#i311 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Yong I Lake Female Date of Death Age If Veteran of U.S.Armed Forces, 03/30/2021 72 Years War or Dates F— Place of Death Hospital,Institution or WCity,Town or Village Corinth Town Street Address 28 Chapman Street,Corinth Town,New York 12822 p Manner of Death ©Natural Cause El Accident 0 Homicide 0 Suicide El Undetermined El Pending VCircumstances Investigation I,U Medical Certifier Name Title 0 John Delmonte MD Address 3 Care Lane,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Corinth 4553 8 0 Burial Date Cemetery,Crematory or Facility Name 04/01/2021 Pineview Crematorium El Entombment Address 0 Cremation Queensbury Town,New York ElDonation 0 ❑Removal Date Place Removed p and/or and/or Held N Hold Address O O. Date Point of N ❑Transportation s by Common Shipment Carrier Destination Disinterment Date Cemetery Address EiReinterment 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 It W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/31/2021 Registrar of Vital Statistics Brenda L Penis(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: I- W Date of Disposition 4 I( I 71 Place of Disposition i nc� A--- 2 (address) W Cr N (section) (lot tuber) (grave number) O Name of Sexton or Person in Charge Jofses /'�11�pint Z ,--- (P P tWSignature Title f!✓I't'i►" iiTIVE DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on ,` i , 20 Y..Y • Pine View Cemetery Repre§enting the funeral home named on burial permit Official Funeral Directors Reg.or License# I