Barton, Elizabeth I Q
NEW YORK STATE DEPARTMENT OF HEALTH t
Vital Records Section Burial - Transit ermit
f Name First Middle Last Sex
Elizabeth H. Barton Female
Date of Death Age If Veteran of U.S. Armed Forces,
September 21, 2016 90 War or Dates
• Place of Death Hospital, Institution or
City, Town or Village Moreau Street Address Home Of The Good Shepherd
:p M• anner of Death X Natural Cause Accident Homicide I I Suicide Undetermined Pending
Ali Circumstances Investigation
g M• edical Certifier Name Title
Pi Elaine Williams ANP
Address
r ti 325 Main Street,Hudson Falls,NY 12839
r▪ Death Certificate Filed District mber Registel,NOumber
:▪ ;: City, Town or Village South Glens Falls 70
❑Burial Date Cemetery or Crematory
September 23, 2016 Pine View Crematory
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F Hold
Cl)
O Date Point of
O.
_ Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
: Permit Issued to Registration Number
• :, Name of Funeral Home Regan Denny Stafford Funeral Home 01443
▪ Address
53 Quaker Road, Queensbury, NY 12804
▪: Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
i1
Address
N.: Permission is hereby granted to dispose of the human remains scrib a ve as indicated.
Date Issued V-►/ct?-/d1(9 Registrar of Vital Statistics
(sig ature)
Cje.
(•--/_ 2 ��
District Number Z J W Place South Glens Falls 3 7 /{_JVIO/�S A(e "
i;::::
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 7 Z3 /gyp Place of Disposition pdi e U ieiJ Cfei
2 (address)
W
U)
CL (section) (lot n}9nber) (grave number)
Q Name of Sexton or Per n in Ch ge of Premises J w 1• ,pi [44-4448-c '
Z (please print)
W
Signature Title C/'Q/7/4. T
(over)
DOH-1555(02/2004)