Scarpati, Elizabeth -it Is L
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of VitaL Records
Name First Middle Last Sex
Elizabeth Scarpati Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/11/2022 93 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Natural Cause 1=1 Accident ❑ Homicide ❑Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
David Cunningham MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 110
❑Burial Date Cemetery,Crematory or Facility Name
02/17/2022 Pine View Crematorium
Entombment ` Address
X❑Cremation Queensbury Town, New York
Donation
0 Removal Date Place Removed
and/or and/or Held
I—t� Hold Address
0
C. Date Point of
Cl) Li Transportation
p 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
F Remains are Shipped,If Other than Above
5 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/16/2022 Registrar of Vital Statistics 9l?egan Morin(Efectronica1Ty Signed)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition Z(ig i 2Z Place of Disposition ro iu` G.i—..
g (address)
W
CC (section) A (lot number) (grave number)
Name of Sexton or Person in Charge of Pre 'ses IA a
(plse print) �,s,
W Signature ��' Title ` � �
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#