Elliott, Kathryn NEW YORK STATE DEPARTMENT OF HEALTH "` ';"' L
Vital Records Section Burial - Transit Permit
G fi' Name First Middle Last Sex
}' Kathryn P. Elliott Female
fiw'' Date of Death Age If Veteran of U.S. Armed Forces,
February 26,2015 94 War or Dates
°'y: Place of Death Hospital, InstitutiorMlirondack Tri-County Health Care
City, Town or Village Johnsburg Street Address Center
Manner of Death X Natural Cause Accident n Homicide _Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
: Daniel Way
Address
HH1=IN,North Creek,NY 12853
4 Death Certificate Filed District Number Register Number
City, Town or Village Johnsburg 5655 -
❑Burial Date Cemetery or Crematory
February 27,2015 Pine View Crematory
El Entorrbment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
Q and/or Address
H Hold
U)
O Date Point of
co Transportation Shipment
p by Common Destination
_ Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
vyv; Permit Issued to Registration Number
'-'—`1 Name of Funeral Home Alexander-Baker Funeral Home 00037
y Address
r m: 3809 Main Street,Warrensburg,NY 12885
F Name of Funeral Firm Making Disposition or to Whom
a Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the humaq
ains described above as indicated.
Date Issued C2— pl�6-`6 Registrar of Vital Statistics a., �, a
.,
(signature
District Number 5�� Place Johnsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition ?I t71 I S Place of Disposition fiyt k.„ L
2 (address)
W
U)
CC (section) t (lot numby) (grave number)
pName of Sexton or Person in Charge of Premises �' govl-
Z ( lease p nt)
W Signature
4._ Title I
(over)
DOH-1555 (02/2004)