Nelson, Elfriede : /59
NEW YORK STATE DEPARTMENT OF HEALTH t t Burial• Records Section Burial - Transit Permit
Name First Middle Last Sex
Elfriede Nelson Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 17,2014 90 War or Dates
Place of Death Hospital, Institution or
ZCity, Town or Village Glens Falls Street Address Glens Falls Hospital
ui
p Manner of Death X Natural Cause I 'Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
O Frances C.Bollinger MD
Address
100 Broad Street,Glens Falls,NY 12801
Death Certificate Filed District Number Registe umber
City, Town or Village Glens Falls 5601 / .e
❑Burial Date Cemetery or Crematory
❑Entombment March 18,2014 Pine View Crematory
Address
❑x Cremation 21 Quaker Rd.,Queensbury,NY 12804
Date Place Removed
ZZ I I Removal and/or Held
and/or Address
H Hold
Cl)
0 Date Point of
N Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped, If Other than Above
2 Address
Le
0.
Permission is hereby granted to dispose of the human remains described a o ,as i Jed.
Date Issued 3-18-14 Registrar of Vital Statistics
(signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition 3 i 8%7 Place of Disposition ,'7v f (/i,GJ �,.,... '( rl I t,�''I
2 (address)
W
N __
(section) �� (l giber) I (grave number)
QName of Sexton or J erso in Char a of Premises — j ✓bi C..l
Z ;` (please./ print)
W Signature .'� L`' � Title C1 Y'ii?' JO 'L .��5 1.
(over)
DOH-1555(02/2004)