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Mayette, Donna L NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Donna L Mayette Female Date of Death Age If Veteran of U.S.Armed Forces, 12/20/2021 77 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village - Saratoga Springs Street Address Wesley Health Care Center Inc p Manner of Death ©Natural Cause Accident Homicide El SuicideUndetermined El Pending W Circumstances Investigation W Medical Certifier Name Title O Rick Teetz MD Address 131 Lawrence St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 748 ElBurial Date Cemetery,Crematory or Facility Name 12/22/2021 Pineview Crematory Entombment Address ]Cremation Queensbury Town,New York ElDonation Z Removal Date Place Removed and/or and/or Held N Hold Address 0 Date Point of N ❑Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address ElReinterment 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 IH 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 12/21/2021 Registrar of Vital Statistics John Paul Franck(Electronically Signed) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition it I ZZ I Z.i Place of Disposition (address) W toCC (section) (lot numbe (grave number) 0 Name of Sexton or Person in Charge of Premises 4 , Se in �A{/1 Z ( P W Signature Title (0601 AIVIL DOH-1555(07/18)p 1 of 2 4 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#