Merrill, Edmay f .
NEW YORK STATE DEPARTMENT OF HEALTH P CD
Vital Records Section Burial - Transit Permit
Name First Middle La Sex
Edmay R Merrill Female
Date of Death Age If Veteran of U.S. Armed Forces,
01/15/2014 95 years War or Dates no
1-r Place of Death Hospital, Institution or
WCity, To,v -. , ' .s- Schenectady Street Address Ellis
0 Manner of Death rrAn%Natural Cause 0 Accident ❑Homicide ❑Suicide ❑Undetermined Li Pending
VCircumstances Investigation
W Medical Certifier Name Title
0 Anthony Malanga M D
Address
124 Rosa Rd, Schenectady, N Y 12308
; ; Death Certificate Filed District Number Register Number
City, ToungrXVX4eXX Schenectady 4601 61
❑B rial Date Cemetery or Crematory
01/20/2014
❑ ntombment Address
Cremation
Queensbury, N Y Pineviewi Crematorium
Date Place Removed
Z Removal
0❑and/or and/or Held
Address
U
Hold
Cy Date Point of
❑Transportation Shipment
L3 by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
r Address
68 Main St, Box 67, Hudson Falls, N Y 12839
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
#r
11
,." Permission is hereby granted to dispose of the human remai s ' scri a a. I as inch ed.
Date Issued 01/17/2014 Registrar of Vital Statistics /e) (f
(signature)
gilil District Number 4601 Place Schenectady
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
LI Date of Disposition IA) J'V Place of Disposition ...eau., 6 lot„_.,
(address)
tLI
U)
rZ (section) (lot number) (grave number)
Q �tzi Name of Sexton or Person i harge of Premises gy.Ark- )t rhit(�
ease print)
iii
>:< Signature Title riim>9mc
(over)
DOH-1555 (02/2004)