Garofalo, Elizabeth Rose LF/
NEW Y ORKSTATE DEPARTMENT OF HEALTH / Burial - Transit Permit
Bureau of Vital Records74 "
Name First Middle Last Sex
Elizabeth Rose Garofalo Female
vb Date of Death Age If Veteran of U.S.Armed Forces,
05/06/2022 92 Years War or Dates
Place of Death
Hospital,Institution or
City,Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause Accident 0 Homicide 0Suicide Undetermined Pending
4° Circumstances Investigation
Medical Certifier Name Title
,: Jeremy Di Bari MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed City Of Glens Falls District Number Register Number
. Cit ,Town or Village 5601 256
X Burial Date Cemetery,Crematory or Facility Name
05/20/2022 Pine View Cemetery
Entombment Address
ICremation Queensbury,New York
DDonation
• ❑Removal Date Place Removed
• and/or
and/or Held
✓• Hold Address
lit
IITransportationDate Point of
by Common Shipment
Carrier Destination
.. Date Cemetery Address
u- Disinterment
I Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
' ' Date Issued 05/09/2022 Registrar of Vital Statistics MeganWohn(E(ectronica/TySigned)
(signature)
,, District Number 5601 Place City Of Glens Falls
r;
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition '5. ap.a-a Place of Disposition Q i gviccve,. Quc- , ' n� 1 4
(address)
..q I
(section) (lot number) (grave number)
, Name of Sexton or Person in Charge of Premises o!l n, (2 R.,1—
(please print) /
W Signature I^4 Title �p�2.f/! 7C1 C/!T
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 012 916
Receipt
Human remains of. - ',,ti . , , delivered on , , , , 20-
ne View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
GAROFALO
NAME Elizabeth Rose Garofalo Age: 92
Lot Owner:Frank & Elizabeth Garofalo
Lot# Erie 3A Grave# 1
Case: Concrete
Died: 5.6.2 2 Interred: 5.2 0.2 2
Funeral Home: Regan Denny Stafford
Cemetery: Pine View
GAROFALO
. (1!)
Lot No. 3A
Address 66 SFliFJ L ST_ I A KF EFJ?RGE N.Y 12845 Section No.
Owner FRANK & ELIZABETH R . GAROFALO Plot ERIE
Date 9/26/06
APPROX . 67 Superficial f t.
Location BOUNDED ON NORTH BY GAROFALO, SOUTH BY ROAD, EAST BY SULLIVAN,
WEST BY VACANT .
Corner Posts
Remarks
Deed No. (and changes) 3445
Payment Record PAID IN FULL 9/26/06 ( $1, 10 0 . 0 0)
Record of Interments �a
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Form No. 01