Robarge, Josph G it/4o
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Joseph G Robarge Male
Date of Death Age If Veteran of US.Armed Forces,
02/18/2022 79 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death
W Natural Cause ❑Accident ID Homicide I=1 Suicide 0 Undetermined ❑Pending
U Circumstances Investigation
UJ Medical Certifier Name Title
CI Timothy Waters DO
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 131
Burial Date Cemetery,Crematory or Facility Name
02/22/2022 Pineview Crematory
0 Entombment Address
0 Cremation Queensbury Town,New York
❑Donation
0 Removal Date Place Removed
and/or and/or Held
Hold Address
N
O
N ❑Transportation Date Point of
Et 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
F. Remains are Shipped,If Other than Above
a Address
OC
W
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/22/2022 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:
ZW Date of Disposition Zi 721"ZZ Place of Disposition r�
2 (ddress)
W
CC W
(section) (lot number) (grave number)
O c
0 Name of Sexton or Person in Cha f Premises lease print/
W Signature Title
DOH-1555(07/18)p 1 of 2
015806
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#