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Elkins, Joseph t t NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex ,?;: Joseph C. Elkins Male 3 Date of Death Age If Veteran of U.S. Armed Forces, ; ? May 21,2016 77 War or Dates NA Place of Death Hospital, Institution or City, Town or Village Queensbury : Street Address Warren Center Manner of Death I XI Natural Cause I I Accident Homicide 1 Suicide Undetermined I�Pending Circumstances Investigation Medical Certifier Name Title I ' Roslyn Socolof MD %: Address 42 Gurney Lane Queensbury,NY 12804 Death Certificate Filed Distri t Number Regis Number City, Town or Village Queensbury ©Burial Date Cemetery or Crematory ❑Entombment May 25, 2016 Pine View Cemetery Address ❑Cremation Quaker Road Queensbury, Queensbury,NY 12804 Date Place Removed Z I I Removal and/or Held and/or Address f"' Hold Cl) O Date Point of NI (Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number .,: Name of Funeral Home Regan Denny Stafford Funeral Home 01443 :r;:; Address 53 Quaker Road, Queensbury,NY 12804 ::; Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address r Permission is hereby granted to dispose of the human remains describe -above as indicated. }s >Date Issued �� 1 1 cQ ` C_ Registrar of Vital Statistics (signature) District Number( ') -_ Place [ p i. r-N (4 C._ b I certify that the remains of the decedent identified above were disposed of in ccordanc with this permit on: W Date of Disposition 5/25/1 6 Place of Disposition Pine View Cemetery, Queensbury, NY W (address) W Horicon 41B 1 (section) (lot number) (grave number) Z Name of Se on or Person in Charge of P(--remises Connie L. Goedert �p (please print) W Signatur �_ f� Title Cemetery Superintendent (over) DOH-1555(02/2004)