Burke, Raymond W ._. ft-A5-
NEWYORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Raymond W Burke Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/24/2022 71 Years War or Dates
t— Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital
p Manner of Death ❑X Natural Cause Accident 0 Homicide Suicide FlUndetermined n Pending
W
U Circumstances Investigation
W Medical Certifier Name Title
0 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 559
Burial Date Cemetery,Crematory or Facility Name
09/26/2022 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
6❑Removal Date Place Removed
- and/or and/or Held
H- Hold Address
U)
0
d Date Point of
Cl)nTransportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
IDReinterment
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
a Address
EC
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/26/2022 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:
I- �I
Z Date of Disposition 01lig'1Z Place of Disposition "I ^�1.— 7400,—
W (address)
W
N CC (section) �/ (lot number) (grave number)
• Name of Sexton or Person in Charge mises cc 4
ti
2
( ease print)
W Title /?6/nrl(Y1(j_
Signature
DOH-1555(07/18)p 1 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#