Peterson, Elinor NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section a % Burial - T ansit Permit
Name First Middle Last Sex
Elinor P. Peterson Female
Date of Death Age If Veteran of U.S.Armed Forces,
I. April 29, 2016 87 War or Dates
2 Place of Death Hospital, Institution or o703& L,4 id. �r�d2 / cd
W
City,Town,or Village Huletts Landing Street Address Residence!ii_c ITS ,(a4ndr, A/Manner of Death Natural Cause Accident Homicide Suicide Undetermined f Pending
O IA
W Circumstances Investigation
U Medical Certifier Name Title
W /(F2iAr ' • ,t- /ice P/4
0 Address
S Po cc-/7yr ey -57RP-e l C.d tli mac, A,ret,o/ 4___ /-?8E 7 .
Death Certificate Filed District Number Register Number
City,Town or Village Huletts Landing
❑Burial Date Cemetery or Crematory
May 3, 2016 Pineview Crematorium
❑Entombment Address
m Q Cremation 21 Quaker Road Queensbury, NY 12804
Date Place Removed
0 0 Removal and/or Held
and/or Address
Hold
0 Date Point of
0 0 Transportation Shipment
D. by Common Destination
Carrier
Date Cemetery Address
6 0
Disinterment
Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
~ Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped,If Other than Above
W Address
A.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 5/3 f/(, Registrar of Vital Statistics i L
(signature)
District Number 5 75 2- Place Huletts Landing,New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I-
2
W Date of Disposition 05/03/2016 Place of Disposition Pineview Crematorium
2 (address)
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It
section 0 (section) ii Clot num r) (grave number)
O Name of Sexton or Person in Charge of P emises G1(It- 1
2 ( lease print) �1i
Signature C� Title ` G �
(over)
DOH-1555 (02/2004)