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Sinksen, Debra J
# 13 7 • .NEW YORK STATE DEPARTMENT OF HEALTH . Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Debra J Sinksen Female Date of Death Age If Veteran of U.S.Armed Forces, 11/04/2021 70 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital lil p Manner of Death ©Natural Cause ❑Accident 1=1 Homicide 0 Suicide ❑Undetermined ❑Pending W U Circumstances Investigation W Medical Certifier Name Title CI Asim Chaudry MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 490 ElBurial Date Cemetery,Crematory or Facility Name 11/08/2021 Pineview Crematory ElEntombment Address ElCremation Queensbury Town,New York EiDonation Z Removal Date Place Removed and/or and/or Held F- Hold Address N 0 O. Date Point of U) ❑Transportation Shipment p by Common 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 H Remains are Shipped,If Other than Above 2 Address LC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/08/2021 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: I - t Z Date of Disposition II I gill Place of Disposition � [L � .4-try Ili 2 ddress LU NCC (section) Art number/ 1 /grave number/ 0Name of Sexton or Person in Cha a of Premises �'" Z ® (pi e print) ` W Signature Z1f Title ` DOH-1555(07/18)p 1 of 2 I e. IF b .'1.5 306 Public Health Law Sec. 4145(2b) Receipt 1 .. Human remains of ' ' delivered on , 20 - J -- .. - . ........, - ..,.... ... Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#