Howe, Ellen 4, 1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
ti Ellen Jane Howe Female
Date of Death Age If Veteran of U.S. Armed Forces,
05/23/2018 65 Years War or Dates
;., Place of Death Hospital, Institution or
City, Town or Village Albany Street Address St Peters Hospital Community Hospice
Manner of Death c Natural Cause 0 Accident ❑Homicide ❑Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Donald Bringley DO
Address
315 S Manning Blvd,Albany,New York 12208
Death Certificate Filed District Number Register Number
City, Town or Village Albany 0101 1130
®Burial Date Cemetery or Crematory
06/15/2018 Pine View Cemetery
['Entombment Address
❑Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
{+ Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
k:-
Name of Funeral Home Bowen&Parker Bros.Funeral Home 00205
Address
97 Old Loudon Road,Latham Hamlet,New York 12110
ZiV Name of Funeral Firm Making Disposition or to Whom
,. Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/24/2018 Registrar of Vital Statistics wanieffe S Gillespie(Electronically Signed)
(signature)
District Number Place
�$ 0101 Albany, New York
t`
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
r Date of Disposition 6/1 5/201 -°lace of Disposition Pine View Cemetery Queensbury
(address)
Erie 6—F 2
'1
1 (section) (lot number) (grave number)
Via' Name of SL or Person in Charge of Premises Connie Goedert
(please print)
Signature � t,1,k IS Y ` V_ Title Cemetery Superintendent
(over)
DOH-1555(02/2004)