Tromblee, David J Sr. it , is 46C
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
David J Tromblee Sr Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/27/2022 79 Years War or Dates 1961-67
f.., Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital
Q Manner of Death El Natural Cause Accident Homicide Suicide Undetermined ❑Pending
W
U Circumstances Investigation
WW Medical Certifier Name Title
0
Qiong Wang MD
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 335
BurialEl]
Date Cemetery,Crematory or Facility Name
05/28/2022 Pineview Crematory
Entombment Address
ZCremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
p and/or and/or Held
N Hold Address
0
a. Date Point of
f/)❑Transportation
p by Common Shipment
Carrier Destination
ODisinterment 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
p— Remains are Shipped,If Other than Above
a Address
Q
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/27/2022 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—
W Date of Disposition . ' 2/-2O7L Place of Disposition ?i/l P V l e 'y t
2 addres
W
Cl)
Q (section) (lot number) (grave number)
Name of Sexton or Person in Cha of Premi KA�N1ON7 &h i
Z (please print)
W Signature ` Title op
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DOH-1555(07/18)p 1 of 2
(''5742
1
1 Public Health Law Sec. 4145(2b)
1
iReceipt
1
1 .
Human remains of .A_ " delivered on , 20 -"
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# 1 f\ '