Pratt, Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
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Name First Middle Last Sex
Elizabeth • Ella Pratt female
Date of Death Age If Veteran of U.S. Armed Forces,
Sept. 10. 2011 62 War or Dates -0-
Place of Death Hospital, Institution or
City, 8E /i� e Glens Falls Street Address Glens Falls Hospital
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CI Manner of Death® Natural Cause 0 Accident 0 Homicide Suicide Undetermined Pending
Circumstances Investigation
ILI Medical Certifier Name Title
el Christopher Hoy, MD
Address
102 Park St. Glens Falls, NY 12801
Death Certificate Filed District Number Reg rNber
City, 4E)i Glens Falls 5601 ��
❑Burial DateSep. 2011 Cemetery or Crematory Pine View Crematorium
13,
❑Entombment Address
®Cremation Tn of Queensbury, NY
Removal Date Place Removed
z and/or Held
and/or
.�^',,
Hold Address
Date Point of
0i. ❑Transportation Shipment
0 by Common Destination
5 Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to RegistratiQr Number
Name of Funeral Home Carleton Funeral Home, Inc. ODU 1
Address
Hudson Falls, NY
Name of Funeral Firm Making Disposition or to Whom
II- Remains are Shipped, If Other than Above
2 Address
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0l' Permission is her y anted to dispose of the huma •mains scribed aQove as indi ated.
Date Issued �3� � Registrar of Vital Statistics / , , 4 41 — e`e_____
(signature)
District Number 5601 Place City of G -ns Falls, NY
I certify that the remains of the decedent identified above -re disposed of in accordance with this permit on:
w Date of Disposition 11 iy f it Place of Disposition f iattuv C 0(OP.
W (address)
CO
a' (section) (lot number) (grave number)
in Name of Sexton or Person • harge of Pr raises dt&sk S„**
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W Signature
Title CDC AJIto12
(over)
DOH-1555 (02/2004)