Hill, Edward F NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Edward F Hill Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/20/2022 68 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Hadley Town Street Address 530 Antone Mountain Road,Hadley Town,New York 12822
pManner of Death 11 Natural Cause Accident El Homicide Suicide Undetermined ri Pending
U Circumstances Investigation
W Medical Certifier Name Title
0 Marena Euashachai DO
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Town Of Hadley District Number Register Number
City,Town or Village 4558 6
HBurial Date Cemetery,Crematory or Facility Name
08/23/2022 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
t❑Removal Date Place Removed
and/or and/or Held
F-
- Hold Address
O
C- Date Point of
N❑Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
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
2 Address
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/22/2022 Registrar of Vital Statistics Colleen Demarsh(Electronically Signed)
(signature)
District Number 4558 Place Town Of Hadley
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IF- n
Z Date of Disposition ro? Z�- azL Place of Disposition ,.j e ✓� ,,,_) C rein, o
2 (address)
W
NCC (section) (lot number) (grave number)
0 Name of Sexton or Person in Charg f Pre ises Tj Gj7/1'1as✓fb l hp
Z (please print)
W Signature Gir G Title O10 -1.41*r-
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) 4
Receipt
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Human remains of delivered on - , 20
Pine View Cemetery Representing the funeral home named,on burial permit
Official Funeral Directors Reg.or License#