Madison, Linda M NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Linda M Madison Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/12/2022 70 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital
p Manner of Death El Natural Cause Accident 0 Homicide Suicide Undetermined []Pending
W V Circumstances ' 'Investigation
0 Medical Certifier Name Title
Maria Vivenzio DO
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 305
BurialEl
Date Cemetery,Crematory or Facility Name
05/16/2022 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
[]Removal Date Place Removed
and/or and/or Held
t— Hold Address
N
0
a Date Point of
(I)❑Transportation
C1 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
E— Remains are Shipped,If Other than Above
• Address
Q
W
C' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/16/2022 Registrar of Vital Statistics Dillon Moran(Electronically Signed)
(signature)
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I-
WDate of Disposition ci/le(7L Place of Disposition6-01-,....._
$ /ad s)
W
U) (section) (lot number) (grave number)
O Name of Sexton or Person in Cha f Premises 'I I lM a'
Z (pleprint)
W Signature Title ++ __)u @kA
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DOH-1555(07/t8)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 j ermit
Official Funeral Directors Reg.or License# ' ''