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Pike, Wanda A
e ' •E °) - b NEW YORK STATE DEPARTMENT OF HEALTH """` Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Wanda A Pike Female Date of Death Age If Veteran of U.S.Armed Forces, 08/31/2021 52 Years War or Dates F— Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital p Manner of Death © Natural Cause Accident Homicide ❑Suicide Undetermined Pending W U Circumstances Investigation Wks Medical Certifier Name Title Derek Smith MD Address 211 Church St,Saratoga S rings,New York 1 862 6 Death Certificate Filed District Number Register Number City,Tow or Village Saratoga Springs 4501 496 ElBurial Date Cemetery,Crematory or Facility Name Ej 09/11/202„1. Pineview Crematory Entombment 1.; Address ''. ElCremation Queensbury Town,New York " '— ElDonation Removal Date ` Place Removed O• ElH and/or and/or Held N Hold Address 0 CL Date Point of (/) 1.1 Transportation p by Comrn�n :ti; Shipment Carrier Deitation ElDisinterment , 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 a Address cr W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/03/2021 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: H Date of Disposition q[Olit Place of Disposition , ilv tL ��_ tii U • (address) 'LI O cr (section) 1(lot number) (grave number) Name of Sexton or Person in Charge of is) ~i iTL, _•tni. If (plea print/ IllSignature Title (Or-,q�( DOH-1555(07/18)p 1 of 2 Uthcial '1 51 4 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#