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Klein, Joseph NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Joseph Klein Male Date of Death Age If Veteran of U.S.Armed Forces, 09/05/2023 72 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Schuylerville Village Street Address 21 Spring Street,Schuylerville Village, New York 12871 Manner of Death El Natural Cause Accident El Homicide Suicide Undetermined El Pending VCircumstances Investigation ▪ Medical Certifier Name Title 0 Paul Byron MD Address 719 719 County Rt 60,Greenwich Town,New York 12834 Death Certificate Filed Village Of Schuylerville District Number Register Number City,Town or Village 4525 002 Burial Date Cemetery,Crematory or Facility Name 09/07/2023 Pineview Crematory Entombment Address ©Cremation Queensbury Town,New York ElDonation 0❑Removal Date Place Removed and/or and/or Held pN Hold Address 0 d Date Point of c ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment 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 F— Remains are Shipped,If Other than Above a Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/07/2023 Registrar of Vital Statistics Helene Patterson(Electronically Signed) /signature) District Number 4525 Place Village Of Schuylerville I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition I(g i 13 Place of Disposition ti,'[_, (address) W IX N (section) 4,11ot number) (grave number) 8 Name of Sexton or Person in Charge of Premis A ri1s.)L 4 ri Z (please print) W Signature Title (Q , . DOH-1555(07/18)p t of 2 + k I .. ..... .. Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named of burial permit •fficial Funeral Directors Reg.or License#