Loading...
Tooker, Ida H le I� NEW YORK STATE DEPARTMENT OF HEALTH �' Bureau of Vitat Records Burial - Transit Permit Name First Middle Last Sex Ida H Tooker Female Date of Death Age If Veteran of U.S.Armed Forces, 07/29/2023 75 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 ILI pManner of Death ZNatural Cause ❑Accident Homicide Suicide Undetermined El Pending V Circumstances Investigation Ui Medical Certifier Name Title Philip Gara MD 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 67 Burial Date Cemetery,Crematory or Facility Name 08/01/2023 Pineview Crematory Entombment Address ___.._ _ ©Cremation Queensbury Town,New York Donation ri ElRemoval Date Place Removed and/or and/or Held Hold Address O Q. Date Point of ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address riReinterment 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 t- Remains are Shipped,If Other than Above 2 Address Q W EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/31/2023 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: F— Z Date of Disposition g/—Z!, Place of Disposition PI` p 3 O etel riot (address) Iii N Q /sedan/ (lot number) (grave number) 0 Name of Sexton or Person in Charge of remiss ��}t',n,,�� t/pda Z (please print) W Signature Title o(�1sq; DOH-1555(07/18)p 1 of 2 Y :'_76F 1 Public Health Law Sec. 4145(2b) • 1 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named o,p lurid permit Official Funeral Directors Reg.or License#