Guiles, Elinor fr
NEW YORK STATE DEPARTMENT OF HEAL' �,l
Vital Records Section Burial - Transit Permit
Name First -Idle Last Sex
Elinor Jane Guiles Female
Date of Death Age If Veteran of U.S. Armed Forces,
December 26, 2014 86 War or Dates
Place of Death Hospital, Institution or
uj City, Town or Village Street Address 114 Crooked Trail
. Manner of Death 0 Natural Cause ❑ Accident ElHomicide ElSuicide ❑ Undetermined ❑ Pending
ILI Circumstances Investigation
W Medical Certifier Name Title
O Darci Gaiotti-Grubbs, M.D Dr.
Address
102 Park Street Glens Falls, NY 12801
Death •- ' icate Filed r 3 District Number Register Number
— City ow • illagekt,
1 „) k8
1-1
4- ❑Burial Date Cemetery or Crematory
December 29, 2014 Pine View Crematorium
' ❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
and/or Address
E, Hold Ziion Church Columbarium
tO Date Point of
IEL 0 Transportation Shipment
by Common Destination
) Carrier
❑ Disinterment Date Cemetery Address
T ❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
°: Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
= Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2- Address
a:
14
Permission is ere yi ranted to dispose of the human ins 'esi r,.ed .o ve as indicated.
Date Issued ,, Registrar of Vital Statistic `)
C 6 1 _ nature)
,'F,, District Number 5 Place ,� 1�Dft IA
I
' r I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
uj Date of Disposition 12/29/2014 Place of Disposition Quaker Road Queensbury,NY 12804
L (address)
CoAU
te (section) /� (lot number) (grave number)
in Name of Sexton or Person in Charge of Premises (Arr -5/44
z (pl ase print)
AU Signature efii A...-- Title (414141vL
(over)
DOH-1555 (02/2004)