Butler, Francis D @ g 4S-1
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital.Records
Name First Middle Last Sex
Francis D Butler Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/13/2022 92 Years War or Dates
F. Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
ILI
p Manner of Death El Natural Cause Accident 0 Homicide OSuicide ❑Undetermined Pending
V Circumstances Investigation
W Medical Certifier Name Title
G Bert Pyle 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 480
EIBurial Date Cemetery,Crematory or Facility Name
08/15/2022 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
a Date Point of
N❑Transportation
p 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
-. Remains are Shipped,If Other than Above
S Address
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/15/2022 Registrar of Vital Statistics Dillon Moran(Electronically Signed)
(signature)
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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:
H
Z Date of Disposition 21110 i-n_ Place of Disposition 7.,ll_
LU
2 address)
W
U)
CC (section) (lobnumber) cuvl, (grave number)
gName of Sexton or Person in Charge of remises 4 6 L 141
z ( ase print)
W Signature Title JJ (W/nliar
DOH-1555(07/18)pi 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#