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Bortell, Elaine Marie NEWYORKSTATE DEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Elaine Marie Bortell Female Date of Death Age If Veteran of U.S.Armed Forces, 01/17/2021 70 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 206 Ferry Boulevard,Moreau Town,New York 12803 W Mannerof Death © ❑ ❑Undetermined Pending 0Natural Cause Accident Homicide Suicide Circumstances Investigation WMedical Certifier Name Title 0' Mark Quaresima MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Moreau 4562 5 ❑Burial I Date Cemetery,Crematory or Facility Name 01/21/2021 Pine View Crematorium ElEntombment Address ElCremation Queensbury Town,New York Donation zRemoval Date Place Removed and/or and/or Held E- Hold Address 0 d' Date Point of U) ❑Transportation tp by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 5 Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/21/2021 Registrar of Vital Statistics Leeann 961c cabe(E(ectronica(Cy Signed) (signature) District Number 4562 Place Moreau, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition Pp73'o20,2 I Place of Disposition e e.-u f tPyst� 2 (address) W (/) CC (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge f Premises W i/YrR Aiei Z 1 please riot/ W Signature �1/ Title O —� DOH-1555(07/18)p i of 2 Public Health Law Sec. 4145(2b) 114 4 4 5 '. Receipt �. Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# i j