Hook, Matthew D NEW YORK STATE DEPARTMENT OF HEALTH 4•t Lf) Burial -Transit Permit
Bureau of Vital Records ``�
Name First Middle Last Sex
Matthew D Hook Male
Date of Death Age If Veteran of U.S.Armed Forces, Fro.,.
11/25/2022 37 Years , War or Dates
H
Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital
p Manner of Death 0 Natural Cause ❑Accident 0 Homicide 0Suicide FlUndetermined ri Pending
W I—ICircumstances Investigation
W Medical Certifier Name Title
0 Danielle Jourdanlip Coroner
Address
4205 Route 50,Saratoga Sprin ,New York 12866
Death Certificate Filed City Of Saratoga Springs District Number Register Number 4,t440r u.
City,Town or Village 4501' 695
Burial Date Cemete rematory or F ccdity Name
11/29/2022 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
D. Date Point of
(/)0Transportation Shipment
Q by Common
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
l. Remains are Shipped,If Other than Above
"' Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/28/2022 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— --, 7
Z Date of Disposition ij JZq _,,,
11L Place of Disposition ,V
W (address)
W
VACC (section) !!/
/,� (lotnumber/ (grave number)
5
0 Name of Sexton or Person in Charge Premises ''
Z (pjase print)
W Signature / Title �ILtnyTzy17
DOH-1555(o7/18)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#