Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Burke Jr., Thomas J
11 ID NEW YORK STATE DEPARTMENT OF HEALTH .1.,..., ,,Or t: Burial - Transit Permit Bureau of VitaL Records Name First Middle Last Sex Thomas J Burke Jr Male Date of Death Age If Veteran of U.S.Armed F s, 01/04/2022 63 Years War or Dates 1978 H Place of Death Hospital,Institution or WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital p Manner of Death ©Natural Cause I=1 Accident ❑Homicide 0 Suicide 0 Undetermined El Pending W U Circumstances Investigation W Medical Certifier Name Title CI Derek Smith MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District'lumber Register Number City,Town or Village Saratoga Springs 4501 5 ElBurial Date Cemetery,Crematory or Facility Name 01/05/2022 Pineview Crematory Entombment Address EiCremation Queensbury Town,New York ElDonation Z 0 Removal Date Place Removed and/or and/or Held t— Hold Address N 0 d. Date Point of CO ❑Transportation Shipment p by Common Carrier Destination Disinterment 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 a Address Q ILLI a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/04/2022 Registrar of Vital Statistics Dillon Moran(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: WI— Date of Disposition 115 12 . Place of Disposition P1— Z4, 2 (address) NCC (section) (lot nu er) (grave number) Name of Sexton or Person in Charge of P ses f+a ,t Z (please print/ W Signature Title � m �� DOH-1555(07/18)p 1 of 2 l Public Health Law Sec. 4145(2b) Receipt �, afi-'�_ Human remains of delivered on , , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#