Pratt, Elizabeth f #Zt3
NEW YORK STATEDEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Elizabeth A. Pratt Female
4 Date of Death Age If Veteran of U.S. Armed Forces,
0` March 11,2017 70 War or Dates
2, Place Death Hospital, Institution or
City(Town)or Village Moreau Street Address 3 Centerbar Heights
, Manner of Death �7'j Natural Cause n Accident f]Homicide (1 Suicide n Undetermined Pending
.. (`� Circumstances Investigation
': , Medical Certifier Name Title
4cku I A-- lC -rr S yx\
Address YlS t ` Z
'>'� Death ertificate Filed District Number Register Number
;; 5 2 /5
City�Tow�or Village Town of Moreau,NY
❑Burial Date Cemetery or Crematory
March 15, 2017 Pine View Crematorium
❑Entombment Address
®Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
ZO Removal and/or Held
and/or Address
�` Hold
N
O Date Point of
yn Transportation Shipment
a by Common Destination
Carrier
pi Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan& Denny Funeral Home 01444
< Address
94 Saratoga Avenue, South Glens Falls,NY 12803 _
r
Name of Funeral Firm Making Disposition or to Whom
:;:' Remains are Shipped, If Other than Above
Address
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`) Permission is hereby granted to dispose of the human remains described above as indicated.
: Date Issued t_J/5)1 7 Registrar of Vital Statistics ��- 41 ?'
4 (signature)
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District Number y 5(e, Place roC✓,,,rt 0 f 41 e ,c e C`
F- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
uiDate of Disposition 3I I S hi Place of Disposition 'Flne0 its.) a,tt_
W (address)
CO
(section) ///(lot number) (grave number)
Q Name of Sexton or Person in Charge of Pre ises l 1 r,, ����t
tZ (plQase print)
Signature a �, Title (ICE MrtrOi?
- (over)
DOH-1555(02/2004)