Ely, Sandra Edith it
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Sandra Edith Ely Female
Date of Death Age If Veteran of U.S.Armed Forces,
06/15/2021 78 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Argyle Town Street Address 271 County Route 45 Route,Argyle Town,New York 12809
Manner of Death
� Natural Cause I:Accident Homicide Suicide Undetermined �Pending
W Circumstances Investigation
W Medical Certifier Name Title
CI Mark Hoffman MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Argyle 5750 42
ElBurial Date Cemetery,Crematory or Facility Name
06/16/2021 Pine View Crematory
Entombment Address
lCremation Queensbury,New York
ElDonation
Z ❑Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
Date Point of
f!) ❑Transportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan&Denny Funeral Service 01444
Address
94 Saratoga Ave,S Glens Falls,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F- Remains are Shipped,If Other than Above
2 Address
CC
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/16/2021 Registrar of Vital Statistics Shelley Mckernon(E(ectronicalty Signed)
(signature)
District Number 5750 Place Argyle, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Ir
Z Date of Disposition (o If1 I /I Place of Disposition t_- 4d1h✓�-
W (address)
W
(section) (lot number)/I%A s ✓c
(grave number)
8 Name of Sexton or Person in Chargey mises �"��'�+�
Z (pl se print)
W Signature Title t K
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) " 1.4 8 5 ti
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#