McElroy, Jean it 3
NEW YORK STATE DEPARTMENT OF HEALTH-- 1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
IV
Jean B. McElroy Female
'.'€ Date of Death Age If Veteran of U.S. Armed Forces,
01 / 12 / 2016 86 War or Dates N/A
}- Place of Death Hospital, Institution or
WCity, Town or Village Wilton Street Address 15 Peach Tree Lane
p Manner of Death iE Natural Cause 0 Accident 0 Homicide 0 Suicide ❑Undetermined 0 Pending
ItitCircumstances Investigation
tij Medical Certifier Name Title
Ct Jennifer Keffer MD
Address
gg 3050 NY-50, Saratoga Springs, NY 12866
Death Certificate Filed District Number .— Registe Number
City,Town or Village Wilton S 6 K 2-
<> 0 Burial Date Cemetery or Crematory
O1 / 13 / 2016 Pine View Crematory
f Entomi ment Address
Cremation 21 Quaker Road, Queensbury, NY
> : Date Place Removed
Removal and/or Held
and/or
Address
Hold
lik
P. Date Point of
tiQ Transportation Shipment
ai by Common Destination
iiiiiiii Carrier
'< 3 Q Disinterment Date Cemetery Address
`ii Q Reinterment Date Cemetery Address
lilPermit Issued to I Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
Address
.iiiiiiil 402 Maple Ave., Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
X Address
E
Permission is hereby granted to dispose of the human remains described a;/ M7
ve indicated.
:iii: /,
Date Issued • . d Registrar of Vital Statistics ;IZ��
(signature)
s District Number (l5 /A Place Wilton , New York
iipoEiN I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 1/i S Ijb Place of Disposition gull», 6144%cytork, ,
(address)
fAll
CC (section) /7• (lot number)r (grave number)
0 Name of Sexton or Person in Ch rge of Premises '1P>> * P"
Z ( lease print) -
Signature ' Title I -�`f `�
(over)
•
DOH-1555 (02/2004)