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Ross, Louis
IIDL$ NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Louis Roos Male Date of Death Age If Veteran of U.S.Armed Forces, 12/05/2021 80 Years War or Dates H Place of Death Hospital,Institution or Z▪ City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause El Accident ElHomicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title O 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 577 0 Burial Date Cemetery,Crematory or Facility Name 12/08/2021 Pineview Crematory ElEntombment Address Cremation Queensbury Town,New York ElDonation Removal Date Place Removed and/or and/or Held A Hold Address O O. Date Point of N ❑Transportation a by Common Shipment Carrier Destination EIDisinterment 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 Remains are Shipped,If Other than Above 2 Address tZ ILl EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/07/2021 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: Z Date of Disposition /Z- �2411 Place of Disposition ?AZV (Ve..**44/67 2 (address) W CC 2 (section) r. (lot number) (grave number) 0 Name of Sexton or Perso in C rge of Premises (4,1 ''nat,f+ (please print) IL Signature N Title m l .0)00.r av DOH-1555(07/18)p 1 2 01•. 41.6 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#