Swinton, Elsie I6Z
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Elsie Swinton Female
Date of Death Age If Veteran of U.S. Armed Forces,
01/30/2018 83 Years War or Dates
F— Place of Death Hospital, Institution or
WCity, Town or Village Ticonderoga Town Street Address Heritage Commons Residential Health Care
Ip Manner of Death Natural Cause ❑Accident El Homicide El Suicide ❑Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
0 Kathleen Huestis MD
Address
1019 Wicker St,Ticonderoga Town,New York 12883
Death Certificate Filed District Number Register Number
City, Town or Village Ticonderoga 1564 8
❑Burial Date Cemetery or Crematory
02/01/2018 Pine View Crematory
❑Entombment Address
®Cremation Town of Queensbury, New York
Date Place Removed
O❑Removal I and/or Held
and/or Address
I= Hold
co -
O Date Point of
11. ❑Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
El
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Edward L Kelly Funeral Home 00519
Address
PO Box 548,Schroon Lake,New York 12870
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
2 Address
W
fl Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/01/2018 Registrar of Vital Statistics Tonya M'Thompson(E1 ctronica1TySigned)
(signature)
District Number 1564 Place Ticonderoga, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition z I I (14 Place of Disposition ►�11� 4...r�
(address)
W
N
(section) Jj (lot numbet}--- (grave number)
pName of Sexton or Person in Charge of Pr ises ( lease print)
Signature W Signature Title coo-Pk
(over)
DOH-1555 (02/2004)