Harris, Katrine J 0 . , A (,)HI
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name FirsT— Middle Last Sex
Female
Katrine J Harris
Date of Death Age If Veteran of U.S.Armed Forces;----'
08/09/2022 68 Years War or Dates
F,. Place of Death Hospital,Institution or
Z City,Town or Village Corinth Village Street Address 312 Oak Street 2,Corinth Village,New York 12822
ILI
0 Manner of Death El Natural Cause Accident Ei Homicide nSuicide FlUndetermined ElPending
W Circumstances Investigation
U Title
UI Medical Certifier Name
0 David DeCelle Coroner
Address
40 McMaster Street,Ballston Spa,New York 12020
Death Certificate Filed Town Of Corinth District Number Register Number
City,Towrior Village 4553 14
Burial Date Cemetery,Crematory or Facility Name
08/12/2022 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
O❑Removal Date Place Removed
and/or and/or Held
t— Hold Address
N
0
Date Point of
N OTransportation Shipment
Q by Common
Carrier Destination
•
Date Cemetery Address
Disinterment
11 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
S Address
2
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/11/2022 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:
I—
WDate of Disposition S (tt 122 Place of Disposition add eI�)
W
O (section) dn,Rotnu�r/ � (grave number)
„.,„„..„,4 tr
O Name of Sexton or Person in Charge of Pre .ses c
(plea print/
w � %/ �l U0/r1�4 2
Signature .. Title
DOH-1555(07/18)p 1 of 2
• 7
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#