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Cole, Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name Elizabeth J fiddle Cole Sex F Date of Death Age If Veteran of U.S. Armed Forces, 10-29-96 71 War or Dates NA Place of Death Hospital, Institution or AM City, Town or Village Johnsburg Street Address River Rd. , North Creek, NY Manner of Death Natural Cause Accident Homicide SuicideEj Undetermined Pending Circumstances Investigation Medical Certifier Name Title Dan Way NID Address HHHN, North Creek, NY Death Certificate Filed District Number 5/S- Register Numbera� City, Town or Village Johnsburg Date Cemetery or Crematory ❑Burial 10-30-96 Pine View Cre-natory Address ©Cremation Queensbury, 'NY Date Place Removed ZRemoval and/or Held p and/or Address Hold Q Date Point of Q Transportation Shipment C by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander-Baker FH 00018 Address Warrensburg, NY ' Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human ains escrib above as indicat-. Date Issued 10-29-96 Registrar of Vital Statistic U (signature) District Number Place T/O Johnsburg, NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition �r�f7- 0'Place of Disposition U (address) LLJ W (section) A ot umber) (grave number) 0 Name of Sexton or Person in Charge of Pr mises 4_�k/f" �'F-r 211 (please print) �S!/ —' Signature Title /a DOH-1555 (10/89) p. 1 of 2 VS-61