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Gilchrist, Duane J. Jr.
i (LF;) 2-1,3 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Duane J Gilchrist Jr Male Date of Death Age If Veteran of US.Armed Forces, 03/06/2023 82 Years War or Dates F. Place of Death Hospital,Institution or WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital p Manner of Death is]Natural Cause Accident ❑Homicide DSuicide Undetermined ri Pending W U Circumstances Investigation W Medical Certifier Name Title 0 Mikhail Mavashev 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 151 Burial Date Cemetery,Crematory or Facility Name 03/08/2023 Pineview Crematory Entombment _ Address ©Cremation Queensbury Town,New York DDonation goRemoval Date Place Removed - and/or and/or Held I—- Hold Address N 0 II. Date Point of U)DTransportation Q by Common Shipment Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address Ej Reinterment 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 2 Address CC Ilf n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/07/2023 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: ZW Date of Disposition 31 h 1 Z, Place of Disposition �iuL 2 (address) W N CC (section) (lot nu (grave number) gName of Sexton or Person in Charge of P mises dtr t.... fi Z (please print) W Title �►(`' en m Signature ___77-7--- DOH-1555(07/18)p 1 of 2 .4 1 t 1 , nM1 Y ? b �„ 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#--