Konis, Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Elizabeth Konis Female
--
`I Date of Death Age If Veteran of U.S. Armed Forces,
May 25, 1996 70 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Street Address Ellis Hospital
Manner of Death ®Natural Cause Acci e t Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Richard Brooks M.D.
Address
1401 Union Street, Schenectady, NY 12308
Death Certificate Filed SCHENECTADY District Number Register Number
City, Town or Village
460 1
Date i C netery or Crematory
❑Burial //7 2, /-e
Address
Cremation
Date X Place Removed
O Removal and/or Held
and/or Address
Hold
Date Point of
NTransportation Shipment
by Common Destination
Carrier
( Date Cemetery Address
Disinterment
Reinterment i Date I Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home ` "�� - �` ``^ rJ O L
Address
i S 4=
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
�-
Permission is her by granted to dispose of the human remairf�J�lescribed abo� s�Idica
Date Issued. Registrar of Vital Statistics r_-- - ✓L��_
Place
'CHENECTAD nature)
District Number
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
fF-
WDate of DispositionL Place of Disposition
W (address)
UJI
>� (section) (lot numb (grave number)
GName of Sexto or Pers in Charge of P emises
(please print) f
Signature 2 04c1' Title
DOH-1555 (10/89) p. 1 of 2 VS-61