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Ashline, Belle M \ # C(i3 (\--01F.) NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Belle M Ashline Female Date of Death Age If Veteran of U.S.Armed Forces, 06/12/2023 89 Years War or Dates t— Place of Death Hospital,Institution or WCity,Town or Village Greenfield Town Street Address 2 Locust Drive,Greenfield Town,New York 12833 0 Manner of Death IZI Natural Cause ❑Accident Ei Homicide Suicide FlUndetermined El Pending Circumstances Investigation W Medical Certifier Name Title Sanjay Taneja MD Address 294 Grand Avenue,Saratoga Springs,New York 12866 Death Certificate Filed Town Of Greenfield District Number Register Number City,Town or Village 4557 14 Burial Date Cemetery,Crematory or Facility Name 06/14/2023 Pineview Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held H it Hold Address 0 Date Point of (I)['Transportation Shipment $ by Common 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 H Remains are Shipped,If Other than Above 2 Address Q W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/13/2023 Registrar of Vital Statistics Karen S.Dowen(Electronically Signed) (signature) District Number 4557 Place Town Of Greenfield I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ���_ C—'I W Date of Disposition (r I(��1 j Place of Disposition �+._�,L- (address) ICJ Q (section) (lot number) (grave number) Name of Sexton or Person in Charge remises lase ti print) p W Signature Title rp-flN1r1 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 1 Pine View Cemetery Representing the funeral home named on burial permit 1 Official Funeral Directors Reg.or License# ,