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Beattie, Ada M COI NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Ada M Beattie Female Date of Death Age If Veteran of U.S.Armed Forces, 11/03/2021 82 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Corinth Village Street Address 223 1/2 Center Street,Corinth Village,New York 12822 11.1 p Manner of Death © Natural Cause ❑Accident Homicide ❑Suicide ❑Undetermined Pending 0 Circumstances Investigation Q Medical Certifier Name Title Aimee Mcmaster Nurse Practitioner,Acute Care Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Corinth 4553 23 ElBurial Date Cemetery,Crematory or Facility Name 11/06/2021 Pineview Crematory El Entombment Address lCremation Queensbury Town,New York ElDonation ZZ Removal Date Place Removed and/or and/or Held t—fN Hold Address 0 O. Date Point of (/) ti Transportation p by Common Shipment Carrier Destination 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 2 Address Q W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/05/2021 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: lr- Z Date of Disposition �1-(!.2D,2/ Place of Disposition ,r` .- e 1)i e� Cr�ta-lo Ill (address)_ W N (section) g (lot number) ( (grave number) 0 Name of Sexton or Person in Charge Premises lq�l /V 1,0ODC (please print) W Signature Title o '»T DOH-1555(07/18)p 1 of 2 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#