Navarra, Emily NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Emily Navarra Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/21/2020 85 Years War or Dates
H Place of Death Hospital,Institution or
W
City,Town or Village Ballston Spa Village Street Address 180 W High Street,Ballston Spa Village, New York 12020
0 Manner of Death 0 Natural Cause 0 Accident 0 Homicide 0 Suicide 0 Undetermined 0 Pending
W U Circumstances Investigation
W Medical Certifier Name Title
G Shelley Justa MD
Address
1783 Route 9 202,Clifton Park Town,New York 12065
Death Certificate Filed District Number Register Number
City,Town or Village Ballston Spa Village 4520 36
--- 0 Burial Date Cemetery.Crematory or Facility Name
10/28/2020 Pine View Cemetery
0 Entombment Address
❑Cremation Queensbury Town,New York
0 Donation
ZO Removal
Date Place Removed
and/or Held
H and/or
N
Hold Address
0
Date Point of
U) Li Transportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
ElReinterment
Permit Issued to Registration Number
Name of Funeral Home Townley&Wheeler Funeral Home 01719
Address
21 Midline Rd,Ballston Lake,New York 12019
Name of Funeral Firm Making Disposition or to Whom
i- Remains are Shipped,If Other than Above
2 Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/22/2020 Registrar of Vital Statistics 7enLee OConnorglectronicallil Signed)
(signature)
District Number 4520 Place Ballston Spa Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F—
W Date of Disposition 1 0/28/2020 Place of Disposition 21 Quaker Rd Queensbury, NY 1 2804
(address)
W Erie 1J 1
Q (section) (lot number) (grave number)
g Name of Sexton Person in Charg remises Connie C;oedert
(please print)
W Signature A Title Superintendent
DOH-1555(07/18)pi of 2
Public Health Law Sec. 4145(2b) 012816
Receipt
I an remains of , ' ' delivered on - , 20'2_)
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
NAVARRA
NAME Emily Navarra Age: 85
Lot Owner: Emily Navarra & Julia Leroux
Lot# Erie 1 J Grave# 1
Case: Concrete
Died: 1 0/21 /2 0 2 0 Interred:1 0/2 8/2 0 2 0
Funeral Home: Townley & Wheeler Fh
Cemetery: Pine VIew