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Johnpeer, Fred A I )\ P. 3 NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records � Burial - Transit Permit c r Name First Middle Last Sex Fred A Johnpeer Male Date of Death Age If Veteran of U.S.Armed Forces, 03/11/2023 97 Years War or Dates 1944-45 E. Place of Death Hospital,Institution or WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital p Manner of Death IZ Natural Cause Accident Ej Homicide 0Suicide Undetermined DPending W U Circumstances Investigation C Medical Certifier Name Title Suzanne Rayeski DO 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 158 Burial Date Cemetery,Crematory or Facility Name 03/13/2023 Pineview Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation o D Removal Date Place Removed and/or and/or Held pN Hold Address 0 0. Date Point of U)DTransportation p by Common Shipment 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 1— Remains are Shipped,If Other than Above 2 Address LC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/13/2023 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: H y�� W Date of Disposition 31 f� 173 Place of Disposition `l `L , (address) W CC N (section) ! (lot number) (grave number) 8 Name of Sexton or Person in Charge)) Premises I f T z /i lf(please print) W Agin4Z?Signature �— Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) kJ Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#