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Hoffman, Karen A
ingic it 5- NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Karen A Hoffman Female Date of Death Age If Veteran of U.S.Armed Forces, 07/16/2023 83 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc pManner of Death Natural Cause Accident Homicide ESuicide FlUndetermined ElPending W V Circumstances Investigation CI Carrie Certifier Name Title Carrie Miron PA Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed Town Of Fort Edward District Number Register Number City,Town or Village 5755 60 Burial Date Cemetery,Crematory or Facility Name 07/18/2023 Pineview Crematory Entombment Address ©Cremation Queensbury Town,New York DDonation g❑Removal Date Place Removed and/or and/or Held ~ Hold Address 0 a. Date Point of N❑Transportation Shipment p by Common Carrier Destination ODisinterment 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 W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/17/2023 Registrar of Vital Statistics Aimee L Mahoney(Electronically Signed) /signature) District Number 5755 Place Town Of Fort Edward I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: .r--'W Date of Disposition '7 1 lg 1 — (Z3 Place of Disposition �c,,,(L (address) W tRLC (section) Pot number/ (grave number) � I !t Name of Sexton or Person in Charge of Premises nt(ple eprint) W Trif Signature Title ��` � DOH-1555(o7/18)p t of 2 '` 3 g 1 - ? '„P Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 1 I Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#