Loading...
Reynolds, Elva NEW YORK STATE DEPARTMENT OF HEALTH VitaiRecords Section Burial - Transit Permit .4 Name First Middle Last Sex Elva M. Reynolds Female .•., Date of Death Age If Veteran of U.S. Armed Forces, May 15,2011 89 War or Dates No Place of Death Hospital, Institution or City, Town or Village Queensbury , Street Address 17 Northrup Dr. tit ? Manner of Death X Natural Cause 1 I Accident 1 !Homicide Suicide ' 1 Undetermined Pending tit Circumstances Investigation ? Medical Certifier Name Title P.' Richard Leach Dr. Address :' 27 Sherman Ave,Glens Falls,NY 12801 Death Certificate Filed District Number Register Number City, Town or Village Queensbury 5657 Li ©Burial Date Cemetery or Crematory ❑Entombment May 18, 2011 j Pine View Cemetery Address Cremation Quaker Road, Queensbury,NY 12804 Date 1 Place Removed Z Removal and/or Held and/or Address IZ Hold N 0 Date Point of 051 1 Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address °i Permit Issued to Registration Number :as; Name of Funeral Home Sullivan Minahan & Potter 01675 : ? Address 407 Bay Road, Queensbury, NY 12804 ;.;.. Name of Funeral Firm Making Disposition or to Whom >w+j Remains are Shipped, If Other than Above BAddress BS gi Permission is hereby granted to dispose of the huma remains described above as indicated. Date Issued , t' IC► �f Registrar of Vital Statistics t; /LLQ._._1 (signature) District Number 5657 Place Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: LIJ Date of Disposition 5/18/11 Place of Disposition Pine View Cemetery (address) y Hudson #3 22 A 4 pCC (section) (lot number) (grave number) Name of Sexton or Pers n in Charge of Premises Michael Genier Z C (please print) W Signature taw Title Superintendent (over) DOH-1555(02/2004)