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Covell, Melissa L li liti/ NEW YORK STATE DEPARTMENT OF HEALTH `�/ - e Bureau of Vital Records BurialTransit P rm Name First Middle Last Sex Melissa L Covell Female Date of Death Age If Veteran of U.S.Armed Fortes, 08/17/2023 51 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Greenfield Town Street Address 2025 Route 9 N Lot 43,Greenfield Town,New York 12833 W W Natural Cause ❑Accident Homicide Suicide Manner of Death Undetermined Pending Circumstances Investigation W Medical Certifier Name Title a Susan Hayes-Masa Coroner Address 40 McMaster Street,Ballston Spa Village,New York 12020 Death Certificate Filed Town Of Greenfield District Number Register Number Ci ,Town or Village A 4557 21 Burial Date Cemetery,Crematory or Facility Name 08/21/2023 Pineview Crematory Entombment Address ©Cremation Queensbury Town,New York ElDonation 6❑Removal Date Place Removed and/or and/or Held F- Hold Address N O ., O. Date Point of U)0Transportation Shipment Q 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 a Address IIC UI U. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/21/2023 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: Z W Date of Disposition d 1Z2 l73 Place of Disposition Fk.(L 4P` a (address) W CAOC (section) (tot number) c (grave number) ii- 0 Name of Sexton or Person in Charge of P ises t' - . "iZ (It se print)W Signature Title l` y,7/n DOH-1555(07/18)p 1 of 2 i Public Health Law Sec. 4145(2b) Receipt Human remains of I delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#