Cole, Elizabeth • 1 P zif 1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
��W'"WWW Elizabeth D. Cole Female
Date of Death Age _ If Veteran of U.S. Armed Forces,
r March 29, 2015 87 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Fort Edward Street Address Fort Hudson Nursing Home
Manner of Death
X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Eileen Spinelli MD
titi Address
Y 9 Care Rd, ueensbu ,NY 12804
;j; Death Certificate Filed District Number Register Number
r,.. City, Town or Village Fort Edward 5755 .5I
LI Burial Date Cemetery or Crematory
March 31, 2015 Pine View Crematory
Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZZ I I Removal and/oY Peld
and/or Address
t' Hold
N
O Date Point of
NTransportation Shipment
Q by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
: Permit Issued to Registration Number
i ' Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 12804
rti. Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
;f Permission is hereby granted to dispose of the human r " sdescribed boy as indicated.
. V 331I�� V
r: Date Issued f 5 Registrar of Vital Statistics
;.;., (signature)
District Number 5755 Place Fort Edward
.:4--
4 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition iI/l J/ Place of Disposition , IA_ � —,
2 (address)
w
CO
O (section) i (lot num{�er) (grave number)
QName of Sexton or Person in Charge of Premises L�4�Nd�, \J,t, -
2 (lease print)
iii
Signature .4_, Title ro47.o►
(over)
DOH-1555(02/2004)