McDonald, Francine L LF
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Francine L McDonald Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/05/2022 93 Years War or Dates
i_ Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death 0 Natural Cause nAccident El Homicide nSuicide Undetermined ri Pending
LLI
0 Circumstances Investigation
W Medical Certifier Name Title
CI Kelly Maley PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 251
HBurial Date Cemetery,Crematory or Facility Name
05/07/2022 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
F. Hold Address
N
0
d Date Point of
N)❑Transportation
p by Common Shipment
Carrier Destination
O
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
H Remains are Shipped,If Other than Above
2 Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/06/2022 Registrar of Vital Statistics Megan Nolin(Electronically Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
( ,
Z Date of Disposition 5I�(tit Place of Disposition ,ta1%L �''�/�,/�"Cj—�
W
2 (address)
W
tij
CC (section) llot number) (grave number)
O ci Name of Sexton or Person in Cha mises Ih t � SI,/Ei
z
Z ( ase print) /�
ICJ Signature Title ` H.-ix
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#