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Huntington, Ella NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Ella Lena Huntington Female Date of Death Age If Veteran of U.S.Armed Forces, 10/22/2021 93 Years War or Dates i,., Place of Death Hospital,Institution or WCity,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc p Manner of Death ©Natural Cause 1=1 Accident 0 Homicide ❑Suicide ❑Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title a Philip Gara MD Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 61 ©Burial Date Cemetery,Crematory or Facility Name 10/28/2021 Pine View Cemetery Entombment Address ❑Cremation Queensbury Town,New York ElDonation Z ❑Removal Date Place Removed and/or and/or Held 1_, Hold Address N 0 Date Point of (/o Li Transportation Shipment © by Common Carrier Destination Disinterment Date Cemetery Address ID 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 fr Remains are Shipped,If Other than Above 2. Address Q W C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/25/2021 Registrar of Vital Statistics Aimee L Mahoney(EfectronicalTy 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: Z W Date of Disposition 1 0.28 .21 Place of Disposition 21 Quaker Rd_ QuP_encb»ry, NI 12804 (address) W LU Ondawa 33B 2 N (section) (lot number) (grave number) Cr a Name of Sextor)r Person in Charge of Premises Connie Goedert Q (please print) W Signature C -6t1(4:t. 4- (U1 CL2-4( Title Superintendent tiJ DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 012878 Receipt Human remains of " ' • delivered on , 20r Pine View Cemetery Representing the funeral home named on buri�nit Official fite Funeral Directors Reg.or License# �' 1I HUNTINGTON NAME Ella Huntington Age: 93 Lot Owner: A,J. & Ella Huntington Lot# Ondawa 33 B Grave# 2 Case: Concrete Died: 1 0 .2 2.21 . Interred: 1 0.2 8.21 Funeral Home: Carleton FH Cemetery: Pine View