Loading...
Blunt, Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH ' 1q cs Vital Records Section Burial - Transit Permit Name First Middle Last Sex Elizabeth L.Blunt Female Date of Death Age If Veteran of U.S. Armed Forces, • 07/05/2018 92 Years War or Dates 4. Place of Death • Hospital, Institution or : City, Town or Village Glens Falls Street Address Glens Falls Hospital • Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑ Undetermined ❑Pending ,.a Circumstances Investigation • Medical Certifier Name Title ":-- Suzanne Rayeski DO ril Address 100 Park St,Glens Falls, New York 12801 D• eath Certificate Filed District Number Register Number - C• ity, Town or Village Glens Falls 5601 327 .;❑Burial Date Cemetery or Crematory 07/06/2018 Pine View Crematory ❑Entombment Address 2.4i ®Cremation Queensbury Town, New York 171 Date Place Removed - ❑Removal and/or Held and/or Address . Hold Date Point of y- ❑Transportation Shipment by Common Destination Carrier .1,:El Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address ii,� Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 i -• ' Address 24 Church Street PO Box 500,Lake Luzerne, New York 12846 . w Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above A• ddress Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/06/2018 Registrar of Vital Statistics RpZ ertA Curtis(Electronically Signed) (signature) Ft D• istrict Number 5601 Place Glens Falls, New York certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Place of Dis position .., ., /! Date of Disposition 7 r 7 id p r. .- (address) (section) (lot umber) (grave number) /A" Name of Sexton or Person in Charge of Premises 4pl "1h (please Print) 41 S• ignature Title Won1G2., (over) DOH-1555 (02/2004)