Knowlton, Harold L t �vl
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Harold L Knowlton Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/14/2022 84 Years War or Dates 1960-62
lH Place of Death Hospital,Institution or
Z City,Town or Village Corinth Village Street Address 100 Beech Street,Corinth Village,New York 12822
W
p Manner of Death []Natural Cause []Accident Homicide Suicide Undetermined Pending
IlJ I Circumstances 4Investigation
W Medical Certifier Name Title
John Pezzulo DO
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed Town Of Corinth District Number Register Number
City,Town or Village 4553 6
Burial Date Cemetery,Crematory or Facility Name
04/18/2022 Plneview Crematory
Entombment Address
aCremation Queensbury Town,New York
Donation
goRemoval Date Place Removed
and/or and/or Held
— Hold Address
N
0
d Date Point of
N❑Transportation
ES by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
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
2 Address
R
W
0' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/17/2022 Registrar of Vital Statistics Brenda L Peris(Electronically Signed)
(signature)
District Number 4553 Place Town Of Corinth
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition L'lig'?2 Place of Disposition
(address)
W
O (section) /�(l(t number) c� � (grave number)
D Name of Sexton or Person in Charge of Pre ' es ^�
(pleas print)
z ,�pp,,
W Signature Title !r-14/N0 h��
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
1 ,
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License# i.i;