Svolos, Elia NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
ELIA GUS SVOLOS MALE
Date of Death l Age If Veteran of U.S. Armed Forces,
2-7-96 84 War or Dates WWII
Place of Death Hospital, Institution or
City, Town or Village Schenectady Street Address Ellis
AU Manner of Death !! Natural Cause E Accident E Homicide E Suicide riUndetermined E Pending
Circumstances Investigation
vi Medical Certifier Name Title
p Dean Limeri MD
Address
460 Saratoga Rd. , Glenville, N.Y.
ii Death Certificate Filed j District Number Register Number
City, Town or Village Schenectady 4601
Date Cemetery or Crematory
XXIBurial 2-12-96 ! Pine View Cemetery
Address
❑Cremation Glens Falls, N.Y.
ZDate Place Removed
Z ❑Removal and/or Held
... and/or Address
Hold
0 Date Point of
05 Q Transportation Shipment
Ei by Common Destination
Carrier
i
0 Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Daly Funeral Home 00469
'. Address
242 McClellan Sst. , Schenectady, N.Y.
iLiP Name of Funeral Firm Making Disposition or to Whom
w"" Remains are Shipped, If Other than Above
Lel Address
Permission is hereby granted to dispose of the human re ins des ` ed abo as in ' fed.
Oli Date issued 2-9-96 Registrar of Vital Statistics
(signature)
4601 Place Sch ' ectady
`.' District Number
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 2/12/96 Place of Disposition Pine View Cemetery, Queens by,ry, NY
2 (address)
0 Hori con 29—A L
CC (section) (lot number) (grave number)
Z Name of Sexton or Person in Charge of Premises Mi chaP1 Lopez
(please print)
W Signature / Title Worki ng Foreman
DOH-1555 (10/89) p. 1 of 2 VS-61
SVOLOS 1 /1•F
Lot No. 2 9-A
address ar T a nP Set i a , NY 1 2 3 02 Section No.
c n
Dwner Plot
Theetria Svolos Pl
m Horicon
Date 2/9/96
APprnx 67 Superficial ft.
Location Bounded on North by Gazetos , South by Vacant , w.Pst" by Gazetos ,
East by Path .
Slorner Posts
Remarks
Deed No. (and changes) 272 4
Payment Record Paid in Full 2/9/96 ( $7 0 0 . 0 0 )
Record of Interments
Elia Gus Svolos 2/12/96
y .n
t -aD
��Ym�}r"► c, �t1�eaS. l�' �?o�c; V
I C
5 X ��
6 N 0
7
8 /A-f'#r
Form No. 01
NAME Svolos , Elia GusF\.
Age: 84
Cause: Natural
Lot Owner: Themetria Svolos
Lot # 29-A Horicon
Grave # 1
Case # Concrete
Died: 2/7/96
Interred: 2/12/9 6
Undertaker: Daly