Brancati, Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH _If
Vital Records Section * • . Burial - Transit ermit
Name First Middle Last Sex
Elizabeth L Brancati Female
Date of Death Age If Veteran of U.S.Armed Forces,
I., November 13, 2013 C� War or Dates NO
Z Place of Death Hospital, Institution or
W City,Town,or Village Granville Street Address Haynes House of Hope
•
G Manner of Death 0 Natural Cause 0 Accident 0 Homicide nSuicide 0 Undetermined 0 Pending
W Circumstances Investigation
() Medical Certifier Name Title
W Dr. Robert Sponza Dr.
Q Address
Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City,Town or Village Granville S756 qt)
❑Burial Date Cemetery or Crematory
November 18, 2013 Pineview Crematorium
❑Entombment Address
0 Cremation Quaker Road Queensbury, NY 12804
Date Place Removed
0 0 Removal and/or Held
and/or Address
l' Hold
0 Date Point of
O0 Transportation Shipment
d by Common Destination
0Carrier
Date Cemetery Address
o 0
Disinterment
Ei
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
~ Name of Funeral Firm Making Disposition or to Whom
itit Remains are Shipped, If Other than Above
W Address
0.
Permission is hereby granted to dispose of the human remains described above asAAin/��dicated.
Date Issued I( i)�5 L,013 Registrar of Vital Statistics / G.;(1G��
(signet re)
District Number 5756 Place Granville,New York
t- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition 11/18/2013 Place of Disposition Pineview Crematorium
2 (address)
N
0 0 (section) aoyiriber) (grave number)
Name of Sexton or Pe i Cha e f remises j '"i,'.Iri
Z (please pri t)
W
Signature Title >.
(over)
DOH-1555 (02/2004)