Peitler, Gerald 4 --)It
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Gerald Peltier Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/20/2022 51 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital
O Manner of Death El Natural Cause []Accident n Homicide []Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
CI Enrico Bravo 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 552
RBurial Date Cemetery,Crematory or Facility Name
09/21/2022 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Z❑Removal Date Place Removed
and/or and/or Held
H N Hold Address
O
a- Date Point of
U)❑Transportation
Es 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
a Address
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/20/2022 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:
M— �✓V'
Z Date of Disposition q I Zl I 71 Place of Disposition E....��
ILI (address) .
W
CO
CC (section) 4 flot number) ` N.-
(grave number/
0 Name of Sexton or Person in Ch of Premises d
Z /jlease print)
v
11.1 Signature Title
DOH-1555(07/18)p i of 2
t
Public Health Law Sec. 4145(2b) f.,. N 2
Receipt
t
Human remains of ' delivered on , 20
Pine"View Cemetery Representing the funeral home named can burial permit
Official Funeral Directors Reg.or License#