Girard, Emma Jane S ,r--� V 1
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Emma Jane Girard Female
Date of Death Age If Veteran of US.Armed Forces,
01/06/2023 101 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare
aManner of Death ❑X Natural Cause Accident Homicide Duicide FlUndetermined ri Pending
W
0 Circumstances Investigation
W Medical Certifier Name Title
a Sandita Seecharan MD
Al Address
4573 State Route 40,Argyle Town,New York 12809
Death Certificate Filed Town Of Argyle District Number Register Number
City,Town or Village 5750 2
Burial Date Cemetery,Crematory or Facility Name
® 01/07/2023 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
0Donation
OZ❑Removal Date Place Removed
and/or and/or Held
1— Hold Address
a)
0
O. Date Point of
N❑Transportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
❑DisintermentEl
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
1.. Remains are Shipped,If Other than Above
g Address
CC
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/06/2023 Registrar of Vital Statistics Shelley Mckernon(Electronically Signed)
(signature)
District Number 5750 Place Town Of Argyle
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 11 1 l Z' Place of Disposition —
W 4___'1<-4—
(address)
W
N CC (section) / (lot number) (grave number)
gName of Sexton or Person in Charge of P miles ?
Z (p ease print)
W Title 67400+trUf
Signature
DOH-1555(070)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#