Webb, Elsa NEW YORK STATE DEPARTMENT OF HEALTi-i 110► li -1Z.
Vital Records Section Burial - Transit Perm
Name First Middle Last Sex
Elsa Joan Webb Female
Date of Death Age If Veteran of U.S.Armed Forces,
9/2/2018 82 War or Dates
�; Place of Death Hospital, Institution or
Z City, Town or Village Queensbury Street Address 2 Honey Hollow Road
W Manner of Death C Natural Cause n Accident ❑Homicide Suicide n Undetermined n Pending
Circumstances Investigation
W, Medical Certifier Name Title
O Dr Don Merrihew,MD
Address
Queensbury,NY
Death Certificate Filed District Number Register Number
City, Town or Village Queensbury,NY 5657 la.g
❑Burial Date Cemetery or Crematory
❑Entombment September 7,2018 Pine View Crematorium
Address
®Cremation 51 Quaker Road,Queensbury,NY 12804
Date 1 Place Removed
Z Removal I and/or Held
and/or Address
H Hold
N
O Date Point of
N L Transportation Shipment
p by Common Destination
Carrier
n Disinterment Date 1 Cemetery Address
n Renterment Date Cemetery Address
i
1
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
I Remains are Shipped, If Other than Above
• Address
re
W''
a. Permission is hereby granted to dispose of the human rema' s s rib* o e • Gated.
Date Issued at- 's-otO 1 c' Registrar of Vital Statistics 0.- �
(signature)
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District Number 6661 Place 40 ` -.). tx..e,,,c:,
I certify that the remains of the decedent identified above were 'sposed of in accord e with t is permit on:
Z
W '7 g
Date of Disposition �� � 1$ Place of Disposition m
Ili
(address)
W (section) (lot nu er) 5 (grave number)
Op Name of Sexton or Person in Charge of Premises (hs 6- !n '
Z �y (please print)
W Signature LZ( 4 Title fl ntet,
(over)
DOH-1555(02/2004)