Coates, Elizabeth K-
NEW YORK STATE DEPARTMENT OF HEALTH -= • ) • 333--
Vital Records Section ,I. t° Burial - Transit Permit
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Name First Mid. e Last Sex
Elizabeth Coates Female
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f{ Date of Death Age If Veteran of U.S. Armed Forces,
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r April 28,2016 80 War or Dates
▪ Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death 1N.:':
X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Sean Bain
0:e Address
.h; 100 Park Street
,rjs Death Certificate Filed District Numberaffj\
Regis u er
: City, Town or Village
❑Burial Date Cemetery or Crematory
May 2, 2016 Pine View Crematorium
❑Entombment Address
❑x Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
1` Hold
O Date Point of
NI I Transportation Shipment
5 by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
rr 1 Name of Funeral Home Regan Denny Stafford Funeral Home 01443
ii:*i Address
,r 53 Quaker Road, Queensbury,NY 12804
{fr Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
•
r::: Date Issued S'J 24 1 (, Registrar of Vital Statistics LAD IL
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(sign ture)
':f-▪' District Number 5 b0) Place 6 L A. kN S 1J Ci
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I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tu Date of Disposition .'Lf lib Place of Disposition /474( ., e ',
W (address)
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O (section) jj pot num r) (grave number)
p• Name of Sexton or Person in Charge Premises Moll," ',^,,�y,�(J
tZ ( lease print)
Signature d Title l(4ete_
(over)
DOH-1555(02/2004)