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White, Ralf P
NEW YORK STATE DEPARTMENT OF HEALTH ' 0__F _ Bureau of Vital Records Burial Transit Permit Name First Middle Last Sex Ralf P White Male Date of Death Age If Veteran of U.S.Armed Forces, 02/23/2024 66 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital W Manner of Death Undetermined Pending W Natural Cause Accident Homicide Suicide V Circumstances Investigation W Medical Certifier Name Title W Mark Weidner MD 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 122 Burial Date Cemetery,Crematory or Facility Name 02/26/2024 Pineview Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed - and/or and/or Held ,,_ I—- Hold Address N 0 I. Date Point of Cl)❑Transportation Q 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 1— Remains are Shipped,If Other than Above 2 Address Q W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/26/2024 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— W Date of Disposition 2(21 (79 Place of Disposition hIaErc,i tPi:n,4tri�T 2 (address) W N Q (section) lotnumber) (grave number) gName of Sexton or Person in Charge of Premises .,---- H Z (plea print) Title W Signature �OIS i �� DOH-1555(07h8)p 1 of 2 8006 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#