Parker, Michele L Lr.,)
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Michele L Parker Female
Date of Death Age If Veteran of US.Armed Forces,
11/03/2022 78 Years War or Dates
f.. Place of Death Hospital,Institution or
WCity,Town or Village Troy Street Address James A.Eddy Memorial Geriatric Center
p Manner of Death El Natural Cause Accident Homicide Suicide FlUndetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 Prabhakar Chava MD
Address
2256 Burdett Ave,Troy,New York 12180
Death Certificate Filed City Of Troy District Number Register Number
City,Town or Village 4102 583
Burial Date Cemetery,Crematory or Facility Name
11/09/2022 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
ZZ❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
4. Date Point of
ETransportation Shipment
p by Common
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
i— Remains are Shipped,If Other than Above
2 Address
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued Registrar Re istrar of Vital Statistics Heather L Mulinio(Electronically Signed)
(signature)
District Number 4102 Place City Of Troy
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f~
Z Date of Disposition II l 9 i'.Z Place of Disposition - )L.
W (address)
Cn
(section) /I (toknumber) (grave number)
0 Name of Sexton or Person in Charge of Premises
(plea*print) /_
W Signature G�i Title `I` d �
DOH-1555(07/18)p id 2
Public Health Law Sec. 4145(2b)
Receipt
1
1 Human remains of delivered on , 20•,
1
1
y
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
I