Loading...
Smith, Michael H. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Michael H Smith Male Date of Death Age If Veteran of US.Armed Forces, 06/28/2021 66 Years War or Dates 1973-1977 H Place of Death Hospital,Institution or WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital 'p Manner of Death ©Natural Cause Accident ❑Homicide El Suicide ❑Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title 0 Numan Rashid MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 355 ElBurial Date Cemetery,Crematory or Facility Name 06/30/2021 Pineview Crematory ❑Entombment Address ElCremation Queensbury,New York ❑Donation Z Removal Date Place Removed O and/or and/or Held W Hold Address 0 a. Date Point of (o ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment 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 Remains are Shipped,If Other than Above 2 Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/29/2021 Registrar of Vital Statistics John Paul Franck(Electronically Signed) (signature) District Number 4501 Place Saratoga Springs, 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 ) /1 I © •-1 Place of Disposition P j v,t� G f e,/►�1.i'�Cy (address) W Ct N (section) �-�^ (lot number) (grave number) 0 Name of Sexton or Person in Ch e of Premises Jj('1' -ti) t fv� Z / (please print) W Signature / Title C/reiv c e DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) } 14 9 nRi Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# % 'r