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Rehm, Ella NEW YORK STATE DEPARTMENT OF HEALTH - ' } Burial -Transit Permit Vital Records Section Name First Middle - Last Sex Ella Rehm Female Date of Death Age If Veteran of U.S.Armed Forces, NO 1. March 31, 2013 78 War or Dates Z Place of Death Hospital, Institution or W City,Town,or Village Dresden Street Address 152 South Bay Road 0 Manner of Death 0 Natural Cause El Accident El Homicide EiSuicide 0 Undetermined 0 Pending W Circumstances Investigation () Medical Certifier Name Title Ill Dr Stall MD 0 Address Castleton Family Health Castleton Vermont Death Certificate Filed District Number 5 1 5`l.. Register Number City,Town or Village2 0 Burial Date April 3, 2013 Cemetery or Crematory Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road, Town of Queensbury Date Place Removed 0 El Removal and/or Held iiii and/or Address f' Hold i 0 Date Point of 0 E Transportation Shipment D. by Common Destination Carrier Date Cemetery Address 0 ii Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Jilison Funeral Home, Inc. 00885 Address 46 Williams Street, Whitehall, New York 12887 I— Name of Funeral Firm Making Disposition or to Whom ix Remains are Shipped, If Other than Above W Address 0. Permission is hereby ganted to dispose of the human emains describedabov as i dicated. Date Issued 4/02/i.! Registrar of Vital Statistics IV1 ice. (signature) District Number 5 "7 5 2 Place Vl'r ,ael �LU]� rn (Dg Ii £yf CA e H I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z tuDate of Disposition y-3wt3 Place of Disposition -Rt.atirqu avetec;v� 2 (address) to 0 (section) /(lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises s enNit III (pledsse print) Signature /4L 4..._ Title QLn e C (over) DOH-1555 (02/2004)