Wood, Stephine M r' e l
-'� �"NEW Y ORK STATE DEPARTMENT OFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Stephanie M Wood Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/01/2022 41 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Corinth Village Street Address 3 Church Street 3,Corinth Village,New York 12822
W
p Manner of Death ❑Natural Cause Accident n Homicide nSuicide ❑Undetermined Pending
UJ
0 Circumstances Investigation
U
W Medical Certifier Name Title
0 Robert Ball Coroner
Address
6010 County Farm Road,Ballston Spa Village,New York 12020
Death Certificate Filed Town Of Corinth District Number Register Number
City,Town or Village 4553 4
Burial Date Cemetery,Crematory or Facility Name
04/04/2022 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
DDonation 4"
OZ❑Removal Date Place Removed
and/or and/or Held
f-N Hold Address
0
Q. Date Point of
U)nTransportation
CI Common Shipment
Carrier Destination
nDisinterment
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
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/04/2022 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:
ZW Date of Disposition L1'yin. Place of Disposition 04.�- �.J�"�/1•-.�.-
2 (address)
W
Q (section) 1 f(lot number) (grave number)
g Name of Sexton or Person in Charge of Premises r (P al e print/ c
A 1 f
Z ,-,1
W Signature — Title `� M w f"
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
I
Pine View Cemetery Representing the funeral home named op burial permit
Official Funeral Directors Reg.or License#