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Weaver, Edward J (1-.76.. ...,!) itt- 1 AI Li c. NEW YORK STATE DEPARTMENT OF HEALTH Burial- Transit Permit Bureau of Vital Records Name First Middle Last Sex Edward J Weaver Male Date of Death Age If Veteran of US.Armed Forces, 08/09/2023 61 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital ILI p• Manner of Death Z Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title CI Dean Reali DO 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 454 Burial Date Cemetery,Crematory or Facility Name "'... 08/12/2023 Pineview Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation Removal Date Place Removed and/or and/or Held H it HoldAddress 0 0- Date Point of N❑Transportation Q by Common Shipment 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 l` Remains are Shipped,If Other than Above a Address C W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/11/2023 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:I— Z Date of Disposition g^/2-20Z5 Place of Disposition pi'-,,e,\/j i v) 6f&f 4i17V UJ (address) W CC (major') / Out number) (grave number) g Name of Sexton or Pe;soninChf Premises J �,,)‘'es,11 v 4'41`,G e (please print) J W Title L fa in 44,0 i y p f tcyl L/ Signature DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) 017194 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License# •