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Andrus, Elizabeth May Jr ZOc . , NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Elizabeth May Andrus Female Date of Death Age If Veteran of U.S.Armed Forces, 02/21/2021 65 Years War or Dates t,.. Place of Death Hospital,Institution or WCity,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc ci Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined El Pending IL Circumstances Investigation W Medical Certifier Name Title 0 Courtney Diamond NP Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 12 Burial Date Cemetery,Crematory or Facility Name 02/23/2021 Pine View Crematorium ElEntombment Address ElCremation Queensbury Town,New York ElDonation Z Removal Date Place Removed and/or and/or Held ii.N Hold Address 0 a. Date Point of V) ❑Transportation p by Common Shipment Carrier Destination El 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 F- Remains are Shipped,If Other than Above 2 Address CC W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/23/2021 Registrar of Vital Statistics Aimee L 9Kahoney(E(ectronically Signed) /signature/ District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition 2("73/2( Place of Disposition 2 (apl W NCC (section) (lot tuber) (grave number) Name of SextonPerson in Charge o mises C4,.:� 'KAil orZ (please prin W Signature Title• �i�1�'t►v} DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 01 4 E T 2 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#