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Mosher, Floyd R
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Floyd R Mosher Male Date of Death Age If Veteran of U.S.Armed Forces, 09/16/2021 73 Years War or Dates 1968-72 F Place of Death Hospital,Institution or W City,Town or Village Corinth Village Street Address 287 River Street,Corinth Village,New York 12822 p Manner of Death ©Natural Cause ❑Accident ❑Homicide El Suicide 0 Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title O Douglas Dennett MD Address 101 Ridge Street,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Corinth 4553 20 ElBurial Date Cemetery,Crematory or Facility Name 09/17/2021 Pineview Crematory Entombment Address Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held H Hold Address 0 a Date Point of N ❑Transportation Shipment a by Common Carrier Destination El 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 CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/16/2021 Registrar of Vital Statistics Brenda L Peris(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: IF— WDate of Disposition 1�/7/ - (� Place of Disposition 9t'�, v,Gsr Cane 4^c(address) W CC f/) (section/ (lot number) (grave number) O ,L'a L J O Name of Sexton or Per in in Charge of Premises (please print/ W fly—+,/ Title (�/ctr;;{� Signature DOH-1555(07/18)p i of 2 i . .1 015150 Public Health Law Sec. 4145(2b) .., 1 1 Receipt ,,,,t., , ; , ,Human remains of delivered on , , 20 ' ,---' ,---- _----; - ,..,.. . -fine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# i ' 'l