Delong, John P gZ�
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
John P Delong Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/25/2021 71 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Valatie Village Street Address Barnwell Nursing And Rehabilitation Center
W
Q Manner of Death XINatural Cause Ei Accident Ei Homicide ElSuicide L jUndetermined EiPending
UJ
Circumstances Investigation
WMedical Certifier Name Title
Kathleen Steiger NP
Address
3230 Church St,Valatie Village,New York 12184
Death Certificate Filed District Number Register Number
City,Town or Village Valatie Village 1023 52
ElBurial Date Cemetery,Crematory or Facility Name
09/28/2021 Pineview Crematory
0 Entombment Address
ElCremation Queensbury Town,New York
0 Donation
1=1Removal Date Place Removed
and/or and/or Held
N Hold Address
0
0- Date Point of
CD ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
El 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
Remains are Shipped,If Other than Above
2 Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/27/2021 Registrar of Vital Statistics Barbara Ann Fischer(Electronically Signed)
(signature)
District Number 1023 Place Valatie Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
lU Date of Disposition q,I 1111,1 Place of Disposition ��(L (./1"Cr--
2 (address
W
CC N (section) Alloitrber) (grave number)
Name of Sexton or Person in Charge of Pre ises
4� �
Z (pleasrint/
•
W 12 +
Signature Title
DOH-1555(07/18)p 1 of 2
"i
arla
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named 9n burial permit
Official Funeral Directors Reg.or License# ' i