Card, Elaine F NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Elaine F Card Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/07/2022 90 Years War or Dates
F., Place of Death Hospital,Institution or
WCity,Town or Village Elizabethtown Town Street Address Elizabethtown Community Hospital
d Manner of Death El Natural Cause DAccident El Homicide ❑Suicide ❑Undetermined ❑Pending
1/10 Circumstances Investigation
ILI Medical Certifier Name Title
0 Rob Demuro MD
Address
75 Park Street PO Box 277,Elizabethtown Town,New York 12932
Death Certificate Filed Town Of Elizabethtown District Number Register Number
City,Town or Village 1552 21
Burial Date Cemetery,Crematory or Facility Name
03/09/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
nDonation
Z❑Removal Date Place Removed
and/or and/or Held
NHold Address
0
O. Date Point of
N El Transportation Shipment
a by Common
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Edward L Kelly Funeral Home 00519
Address
PO Box 548,Schroon Lake,New York 12870
Name of Funeral Firm Making Disposition or to Whom
F- Remains are Shipped,If Other than Above
a Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/09/2022 Registrar of Vital Statistics Janet E.Cross(`E4 ctrPnicalf/S084
(signature)
District Number 1552 Place Town Of Elizabethtown
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H ( �
Z Date of Disposition 3/10( ZZ Place of Disposition �1LV�. . t0I►.---
U J
g (address)
W
NLC (section) ,I /tot number) (grave number)
S N of Sexton or Person in Char e of Premises re' ` �'4��"
ame
Z (please print)
W may' '_" Title kEatPtTO)�
Signature
DOH 1555 lo7/18)p 1 of 2
O F 8
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20 `
1
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#