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Merrett, Elisabeth NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Perlit Bureau of Vital Records Name First Middle Last Sex Elisabeth Merrett Female Date of Death Age If Veteran of U.S.Armed Forces, 01/12/2020 84 Years War or Dates }. Place of Death Hospital,Institution or WCity,Town or Village Malta Town Street Address Home of The Good Shepherd Mannerof Death ©Natural Cause El Accident Homicide Suicide Undetermined Ej Pending Circumstances Investigation QMedical Certifier Name Title Suzanne Blood MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Malta 4560 4 Burial Date Cemetery,Crematory or facility Name 01/13/2020 Pine View Crematorium Entombment Address Lej Cremation Queensbury Hamlet,Warren,New York Donation ❑Removal Date Place Removed 0 and/or and/or Held Hold Address Transportation Date Point of L] by Common Shipment Carrier Destination Disinterment Date Cemetery Address JE]Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address Q W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/13/2020 Registrar of Vital Statistics Jennifer 3farie7fofines(EfectronicalTysigned) /signature) District Number 4560 Place Malta, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 114 7,o Place of Disposition W (address/ (section) I (Am number) (grave number) 0 Name of Sexton or Person in Charge of Pr emi � Lt) WSignature Title / ase prin DOH-1555(07/18)p t of 2 s- w Public Health Law Sec. 4145(2b) 013238 Receipt Human remains of 1 . �` t J - delivered on Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#