VanVranken, Elsie L.F
Town of Queensbury
Certification of Cremation
�„ Pi.marne View Cemetery and Crematory
This certifies that the remains of: Elsie VanVranken
were cremated on September 15 20 22 at the Pine View
(Month) (Day)
Crematorium, Queensbury, New York, and these are the cremated remains of said body.
Date of Death September 12 20 22 Age 94
(Month) (Day)
Funeral Home Carleton Funeral Home Registered No. 731
(Authorized Signature)
# 731
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Elsie C.VanVranken Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/12/2022 94 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
'p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
0 Kasandra Frasier PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
,Town or Village 5601 464
Burial Date Cemetery,Crematory or Facility Name
09/14/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
goRemoval Date Place Removed
and/or and/or Held
t-N Hold Address
0
O. Date Point of
Cl) Transportation
a 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
I— Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/14/2022 Registrar of Vital Statistics Megan Nolin(ECectronicary 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:
Date of Disposition q its 11 Place of Disposition ) G
2 (address)
W
(section) (lot number) (grave number)
8 Name of Sexton or Person' of Premises g"
Z5(please print)
W Signature Title `von
t
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named;o! -14.ffi,a1 permit
Official Funeral Directors Reg.or License#
VANVranken
NAME Elsie VanVranken ge: 94
Lot Owner: Thomas A & Elsie C. VanVranken
Lot# S&I #2 Lot 65 Grave# 3
Case: Urn
Died: 9. 1 2.2 2 Interred: 9 .2 4.2 2
Funeral Home: Carleton FH
Cemetery: Pine View
VanVRanken
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Lot No. 65
Address 42 Burgoyne Ave. Hudson Falls. W.V. 12839 Section No. 2
Owner Thomas A. & Elsie C. VanVRanken Plot S.T.
Date 2/21/84
Approx. 133 Superficial ft. @
v
Location
Bounded North by Babcock & Olson, South by Vacant & LaCarte, East by Road, West by ilso
Corner Posts
Remarks
Deed No. (and changes) 1840
Payment Record paid In Full 2/21/84
Record of Interments _ ,1_12_c ci c L.,‹ .4 - _1.____
1 I i{ I i t -Jr`--`1
2 Thomas Allen VanVRanken (3/16/2009)
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Form No. 01