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Hemmy, Rodette A
NEW YORK STATE DEPARTMENT OF HEALTH - Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Rodette A Hemmy Female Date of Death Age If Veteran of U.S.Armed Forces, 09/03/2021 55 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital UJ p Manner of Death ©Natural Cause ❑Accident 0Homicide EiSuicide El Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title 0 Mathew Varughese DO Address • 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 378 ElBurial Date Cemetery,Crematory or Facility Name 09/07/2021 Pineview Crematory ElEntombment Address 0 Cremation Queensbury Town,New York ❑Donation Z El Removal Date Place Removed and/or ='. `� and/or Held H Hold ," Address U) 0 0U. Date Point of Cl) ❑Transportation Shipment Q by Common Carrier Destination 0 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 H Remains are Shipped,If Other than Above a Address !Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/06/2021 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F /t-0�L'1 Z Date of Disposition GI � �n(g� Place of Disposition c{/, W (address) W N (section) (lot number) (grave number) • Name of Sexton or Person in Charge of P ises 4114 1r+r-- S A�it Q (pledse print/ Z Z l li' ,n Of'Det W Title Signature DOH-1555(o7/18)p 1 of 2 4 '_51 ` 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#