Weber, Elfriede NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Elfriede M. Weber Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 2, 2012 93 War or Dates
F... Place of Death Hospital, Institution or
Z City, Town or Village Fort Edward Street Address Fort Hudson Nursing Home
QManner of Death (Xl Natural Cause Accident 1 'Homicide Suicide Undetermined Pending
W Circumstances Investigation
us Medical Certifier Name Title
O Eileen Spinelli,MD
Address
Queensbury,NY
Death Certificate Filed District Number Register N er
City, Town or Village Fort Edward,NY � 5 7'7 -- /-
El Burial Date Cemetery or Crematory
[Entombment March 6, 2012 Pine View Cemetery
Address
❑Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZO Removal and/or Held
and/or Address
I' Hold
V
O Date Point of
NI 'Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
j Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton-Healy Funeral Home 01596
Address
407 Bay Road,Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
t Remains are Shipped, If Other than Above
5 Address
ltf
0 Permission is ere y granted to dispose of the huma ains desc'("
a abov as indicated.Date Issue Registrar of Vital Statis . sII2fli2/1
Q
(signature)
District NumberJ,3 5 Place Fort Edward,NY
I• certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition 3/6/1 2 Place of Disposition Pine View Cemetery
(address)
W
N Mohican 49 C 2
W (section) (lot number) (grave number)
aName of Sexton or Perso in Charge of Premises Michael Genier
Z c (please print)
Ill Signature ,Qti Title Superintendent
(over)
DOH-1555(02/2004)