Loading...
Kirkpatrick, Denise v7q • NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Denise Kirkpatrick Female Date of Death Age If Veteran of U.S.Armed Forces, 08/14/2021 56 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital • Manner of Death g © Natural Cause �Accident �Homicide �Suicide �Undetermined Pending W Circumstances Investigation W• Medical Certifier Name Title Sergio Lema-Gutierrez MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 444 ❑Burial Date Cemetery,Crematory or Facility Name 08/16/2021 Pine View Crematorium Entombment Address ElCremation Queensbury Town,New York ❑Donation • Removal Date Place Removed and/or and/or Held Hold Address N O Date Point of (/) ❑Transportation Shipment Q by Common Carrier Destination Date Cemetery Address ❑Disinterment Date Cemetery Address Reinterment Permit Issued to Registration Number Name of Funeral Home William J Burke&Sons Funeral Home 01827 Address 628 N Broadway,Saratoga Springs,New York 12866 Name of Funeral Firm Making Disposition or to Whom t- Remains are Shipped,If Other than Above Address CC W EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/16/2021 Registrar of Vital Statistics John Pau(Eranck(ECectronicaCCy 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 1")(Z� Place of Disposition ��(address) W CC N (section) (lot number) (grave number) g - 4 Name of Sexton or Person in Charge of Pr ises `ti 40 44 (p ase print) Z W ( eiVr t Signature Title DOH-1555(07/18)p 1 of 2 150".�3 Public Health Law Sec. 4145(2b) Receipt Human remains of -. r • t: t delivered on , 20 2- • t Pine View Cemetery `Representifig'the funeral home named,on burial permit Official Funeral Directors Reg.or License# tY