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Madison, Robin M
OF ,,,, NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit P Lermit Bureau of Vital Records Name First Middle Last Sex Robin M Madison Female Date of Death Age If Veteran of U.S.Armed Forces, 05/24/2023 61 Years War or Dates i,,. Place of Death Hospital,Institution or WCity,Town or Village Corinth Village Street Address 6 Saratoga Avenue,Corinth Village,New York 12822 O Manner of Death El Natural Cause ❑Accident ❑Homicide ESuicide FlUndetermined ElPending W Circumstances Investigation W Medical Certifier Name Title O John Delmonte MD Address 3 Care Lane 300,Saratoga Springs,New York 12866 Death Certificate Filed Town Of Corinth District Number Register Number City,Town or Village 4553 11 Burial Date Cemetery,Crematory or Facility Name 05/26/2023 Pineview Crematory Entombment — Address ©Cremation Queensbury Town,New York Donation 6❑Removal Date Place Removed and/or and/or Held i Hold Address N 0 (1. Date Point of U)❑Transportation Shipment S by Common Carrier Destination E Date Cemetery Address Disinterment E 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 CC W Cl. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/25/2023 Registrar of Vital Statistics Brenda L Penis(Electronically Signed) (signature) District Number 4553 Place Town Of Corinth I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition 51 7b 113 Place of Disposition Ft—`L 2 (address) W NCC (section) lot number) „awl (grave number) g Name of Sexton or Person in Charge of Premises " L rt- fi (pt se print) W Signature __ ( e DOH-1555(07/18)p 1 of 2 i 'A 994 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#