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Darling Jr, Kenneth R joit NEW YORK STATE DEPARTMENT OF HEALTH Transiti�-1 Burial- Permit Bureau of Vital Records Name First Middle Last Sex Kenneth R Darling Jr Male Date of Death Age If Veteran of U.S.Armed Forces, 03/12/2023 75 Years War or Dates 1967-69 i,,, Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital p Manner of Death N Natural Cause Accident 0 Homicide Suicide riUndetermined El Pending W U Circumstances Investigation W Medical Certifier Name Title CI Hung Nguyen 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 165 Burial Date Cemetery,Crematory or Facility Name 03/15/2023 Pineview Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation ❑Removal Date Place Removed and/or N and/or Held F- Hold Address Gam. Date Point of M ElTransportation Shipment a by Common Carrier Destination Date Cemetery Address Disinterment El 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 CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/14/2023 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: Z▪ Date of Disposition 3 I IS 1 z 3 Place of Disposition U- ird ddress) N (section) i (lot number) (grave number) IX Name of Sexton or Person in Charge of 'ses ! L' &-----j-Art. loiease print) Z (�czil Ili Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) . Receipt Human remains of delivered on , 20 I Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#