Brady, Elaine M. f ��G,
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Elaine M.Brady Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/18/2019 81 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
Michael Miles MD
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed District Number Register Number
City,Town or Village Fort Edward 5755 107
❑Burial Date Cemetery,Crematory or Facility Name
12/20/2019 Pine View Crematory
Entombment Address
Cremation Queensbury,New York
Donation
Z Removal Date Place Removed
O and/or and/or Held
F-t� Hold Address
dDate Point of
N R Transportation Shipment
Q by Common
Carrier Destination
Disinterment
Date Cemetery Address
10 Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F.. Remains are Shipped,If Other than Above
' Address
Q
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/20/2019 Registrar of Vital Statistics /gimeeMw oney(Ekctronicatr Srgned)(signature)
District Number 5755 Place Fort Edward, New York
1 certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition %A_Z//t Place of Disposition ,`,ej ('t' P
W (address)
W
N (section/ ( t number) (grave number)
r� J
Name of Sexton or Person in Charge of Pr ises '4 ���'� �' e��
Z (please print)
W Signature ��t� Title 4 r
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 131.G'''
Receipt
Human remains of delivered on , 20_
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#