Harris, Eleanor NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Eleanor Maryjoy Harris Female
Date of Death Age If Veteran of U.S. Armed Forces,
m 11/09/2018 96 Years War or Dates
°gPlace of Death Hospital, Institution or
City, Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing
Ci Manner of Death®Natural Cause El Accident O Homicide El Suicide Undetermined ri Pending
Circumstances Investigation
W, Medical Certifier Name Title
0 Roslyn Socolof MD
Address
,‘ 42 Gurney Ln,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
A City, Town or Village Queensbury 5657 160
'Y OBurial Date Cemetery or Crematory
11/14/2018 Pine View Crematorium
U Entombment Address
f ®Cremation Queensbury Town, New York
{ Date Place Removed
d ri O Removal and/or Held
and/or Address
Hold
Date Point of
(.0.O Transportation _ Shipment
a by Common Destination
Carrier
.y O Disinterment Date Cemetery Address
Reinterment Date Cemetery Address 1=1
Permit Issued to Registration Number
A Name of Funeral Home Carleton Funeral Home inc 00281
Address
`i 68 Main Stpo Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
• Address
I
a Permission is hereby granted to dispose of the human remains described above as Indicated.
Date Issued 11/13/2018 Registrar of Vital Statistics Caroline XBar6ertE1ectronicatlySigned)
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
z ��
WW Date of Disposition iJ I/5'I if Place of Disposition 67NA ,... �,+.c, .fr(„',
(address)
W
II (section) /pot numIer) (grave number)
Name of Sexton or Person in Charge of Pr raises I 46+ 1.. PAAlvt''
(pleae print)
Signature (ram Title iv'•oh►' yz_
(over)
DOH-1555 (02/2004)