Nace, Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
r-
, Name First Middle Last Sex
Elizabeth Greer Nace Female
Date of Death Age If Veteran of U.S. Armed Forces,
August 3, 2016 65 War or Dates
F-` Place of Death Hospital, Institution or
WCity, Town or Village Queensbury Street Address 30 Owen Avenue
W Manner of Death Natural Cause ❑ Accident ❑ Homicide El Suicide ❑ Undetermined ❑ Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 Timothy Murphy,
Address
52 Haviland Ave Glens Falls, NY 12801
" Deat - . cate File �-� ' � District Number R 'ster Number
` a , Ci , Tow o Village�--X L` A4) o(S- n c)
' 0 B Date Cemetery or Crematory
❑Entombment
Address
❑Cremation
:v Date Place Removed
❑ Removal and/or Held
• and/or Address
I- Hold
to Date Point of
IL ❑Transportation Shipment
tl!' by Common Destination
Carrier
tilt
Disinterment
Date Cemetery Address
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
W Remains are Shipped, If Other than Above
$l Address
Cel
LtI
Permission is hereby granted to dispose of the human ren ins described aboy 141dicated.
Date Issued 21 S l,)U (� Registrar of Vital Statistics _1c._ Q, u a1-______
,---_______ (si tune)
District NumbercL - ) Place � CD
Cj«�, Q-
I certify that the remains of the decedent identified above were disposed of in acco ance with his permit on:
Lll= Date of Disposition 08/08/2016 Place of Disposition
W (address)
Clo (section) Ai(lot number) S (grave number)
• Name of Sexton or Person in Charg of Premises a[w:rtyi�- E"
z (pl se print)
W Signature a Title ( +t
--q
(over)
DOH-1555 (02/2004)