Ives, Raymond H (2) 10F
If�r7NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last
Raymond H Ives Sex
Date of Death Male
Age If Veteran of U.S.Armed Forces,
07/11/2022 81 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village
W Saratoga Springs Street Address Saratoga Hospital
Q Manner of Death I I Natural Cause Accident Homicide nSuicide (Undetermined ❑Pending
111
1
U "Circumstances Circumstances Investigation
QW Medical Certifier Name Title
Numan Rashid 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 409
Burial Entombment Date Cemetery,Crematory or Facility Name
07/13/2022 Pineview Crematory
Address
Cremation Queensbury Town,New York
Donation
❑Removal Date Place Removed
4,3
f„ and/or and/or Held
N Hold Address
0
a Date Point of
U)❑Transportation
15 by 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
2 Address
CC
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/12/2022 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
Date of Disposition ")1131It Place of Disposition 4344 Vbi— / ,�.
(address)
W
N
CC
/section) A (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises t/1 A,i1�- �`�
Z e (ple a print)
W Signature Title (Ristglt
I
D0 H-1555(07/i8)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#