Lynch, Amulou c)
a.
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Amylou Lynch Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/25/2022 76 Years War or Dates
i... Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
W
p Manner of Death ❑X Natural Cause Accident Homicide Suicide ❑
W Er Pending
V Circumstances Investigation
G Medical Certifier Name Title
Santosh Vaghela 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 445
BurialE
Date Cemetery,Crematory or Facility Name
07/27/2022 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
p
and/or and/or Held
CO Hold Address
0
d Date Point of
N❑Transportation
p by Common Shipment
Carrier Destination
ElDisinterment 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
a Address
EC
W
C" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/26/2022 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:
F—
W Date of Disposition ?/L f ,r Place of Disposition p j v; (4 z,..F; .Cs/
(address)
UI
cc
N (section) (lot number) (grave number)
SName of Sexton or Person in Charge of Premises J t i 'i Y S r.t.5
Z (please print/
W Signature 1 Title C'r1"
DOH-1555 Witp t of z
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#