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Towers, Berta Mae
(1.7. O.\ NEW YORK STATE DEPARTMENT OF HEALTH Burial- Transit Permit Bureau of Vital Records Name First Middle Last Sex Berta Mae Towers Female Date of Death Age If Veteran of U.S.Armed Forces, 02/13/2022 84 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Corinth Village Street Address 20 Paris Ave.,Corinth Village,New York 12822 p Manner of Death ©Natural Cause Li Accident 12 Homicide ❑Suicide Undetermined ❑Pending W Circumstances Investigation IILI Medical Certifier Name Title 0 Marena Euashachai DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Corinth 4553 2 ElBurial Date Cemetery,Crematory or Facility Name 02/15/2022 Pineview Crematory EiEntombment Address X❑Cremation Queensbury Town,New York ElDonation Removal Date Place Removed and/or and/or Held H N Hold Address 0 a Date Point of Cl) �Transportation Q by Common Shipment 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 Remains are Shipped,If Other than Above M Address W EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/15/2022 Registrar of Vital Statistics Brenda L Pens(Electronically Signed) (signature) District Number 4553 Place Corinth, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Ii— WDate of Disposition 21jS121. Place of Disposition 491/4b` 2 (address) W cr (section) liotnumber) ` "' -� (grave number) 0 Name of Sexton or Person in Charge of Premises 11) L �l /phase print) �} W J� m�! 9 Signature Title DOH-1555(07/18)p 1 of 2 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#