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Guilder, Thomas L Sr. it (3 NEW YORK STATE DEPARTMENT OF HEALTH Burial- Transit Permit Bureau of Vital Records Name First Middle Last Sex Thomas L Guilder Sr Male Date of Death Age If Veteran of U.S.Armed Forces, 01/18/2022 73 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital p Manner of Death ©Natural Cause ❑Accident EIHomicide El Suicide El Undetermined ❑Pending W Circumstances Investigation C.) W Medical Certifier Name Title 0 William Kufs MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 48 Burial Date Cemetery,Crematory or Facility Name 01/20/2022 Pineview Crematory ElEntombment Address 0 Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held N Hold Address 0 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 Remains are Shipped,If Other than Above a Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/19/2022 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: Z Date of Disposition /20 IR Place of Disposition \,11/1 (a?AA W CO (section) (lot number) (grave number) Name of Sexton or Person in Charge of P ises c IA`— Sine tt lease print) W Signature Title �Y DOH-1555(07/18)p 1 of 2 015566 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#