Cone, Ellen VEW NORK STATE DEPARTMENT OF HEALTH
ital Records Section Burial - Transit Permit
Name First Middle Last Sex
Ellen Jean Cone Female
Date of Death Age If Veteran of U.S. Armed Forces,
January 26, 2015 87 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls, NY Street Address Glens Falls Hospital
pManner of Death in Natural Cause n Accident n Homicide n Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Shahid Ahmed,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls,NY 5601 Lj 7
❑X Burial Date Cemetery or Crematory
January 31,2015 Pine View Cemetery
❑Entombment Address
El Cremation Quaker Road, Queensbury, , NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
H Hold
W
0 Date Point of
ej n Transportation Shipment
p by Common Destination
Carrier
n Disinterment Date Cemetery Address
n Renterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped, If Other than Above
2 Address
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued i`21 j 1.5 Registrar of Vital Statistics LA) c.(, �• (1
(signatur
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 1 /3 1 /201 5Place of Disposition 21 Quaker Rd, ,Queensbury, NY 1 2804
(address)
W
coUnadilla Ext. 27B 3
(section) (lot number) (grave number)
pName of Se n or Person in Charge of Premises Connie Goedert
Z J (please print)
W r <d e�
Signature Title Cemetery Superintendent
(over)
DOH-1555(02/2004)