Burritt, Catherine Brown t I
'
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Catherine Brown Burritt Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/01/2022 89 Years War or Dates
1— Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
W Manner of Death nUndetermined Pending
111
Natural Cause Accident Homicide Suicide n
V Circumstances Investigation
W Medical Certifier Name Title
G Courtney Diamond NP
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 194
Burial v Date Cemetery,Crematory or Facility Name
111111111' 04/04/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
O. Date Point of
UI Transportation
by Common Shipment
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
2 Address
CC
ILLI
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/04/2022 Registrar of Vital Statistics Megan Nolin(Electronically Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H Z Date of Disposition '7 l,
_L,-1 j'. Place of Disposition f ray 0(1;614)
W (address)
W
N CC (section) (lot number) (grave number)
_
8 Name of Sexton or Per in arge of Premises w+''t
Z (please print)W Signature �— Title elm 7 fee
DOH-1555(07/18)p 1 of 2 y
I
Public Health Law Sec. 4145(2b)
1
1 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#