Burke, Lori L 57
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle
Lori L Burke Last Sex
Date of Death Female
I Age If Veteran of U.S.Armed Forces,
06/29/2022 45 Years
War or Dates
Place of Death
Hospital,Institution or
W City,Town or Village Corinth Town Street Address 77 Stark Road,Corinth Town,New York 12822
Manner of Death Natural Cause
❑Accident nHomicide Suicide Undetermined !Pending
LU Medical Certifier Circumstances Investigation
0 Name Title
Eugene Ladue Coroner
Address
31 Woodlawn Ave.,Saratoga Springs,New York 12866
Death Certificate Filed Town Of Corinth District Number
-City,Town or Village 4553 Register Number
15
Burial Date Cemetery,Crematory or Facility Name —
® 07/02/2022 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
N Hold Address
0
a Date Point of
W❑Transportation
aby 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
1-. Remains are Shipped,If Other than Above
M Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/01/2022 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:
�
Date of Disposition �Z—Zt77Z Place of Disposition Y ' , e Li:eta.) Cr, >�"
(address)
W
0 (section) (lot number) (grave number)
CC
Name of Sexton or Person in Cha of Premi s �A��'Y�U�� -
Z N p T ease p t/
W Signature Title Oeare f D I —
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#