Corlew, Estella E NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records ----
Name First Middle Last Sex
Estella E.Corlew Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/22/2022 90 Years War or Dates
Place of Death Hospital,Institution or
City,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing
ELI
0 Manner of Death El Natural Cause Accident El Homicide Suicide ❑Undetermined FlPending
ILI
Circumstances Investigation
g Medical Certifier Name Title
Jean Harris-Letts MD
Address
278 Vermont Route 149,Pawlet,Vermont 05775
DeaFth Certificate Filed Town Of Granville District Number Register Number
City,Town or Village 5756 59
Burial Date Cemetery,Crematory or Facility Name
09/23/2022 Pineview Crematorium
Entombment Address
EICremation Queensbury Town,New York •
❑Donation
0 Li Removal Date Place Removed
—• and/or and/or Held
Hold Address
0
!1. Date Point of
0❑Transportation
5 by Common Shipment
i Carrier Destination
❑Disinterment
Date Cemetery Address
IDReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Mason Funeral Home 01117
Address
18 George St Po Box 277,Fort Ann,New York 12827-0277
Name of Funeral Firm Making Disposition or to Whom
E. Remains are Shipped,If Other than Above
5 Address
CC
1t#
A. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/23/2022 Registrar of Vital Statistics Jenny Linda M Martelle(Electronically Signed)
(signature/
;
District Number 5756 Place Town Of Granville
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition '11.3 I i7 Place of Disposition t,r IL __/"(v—
iii
a (a dress)
Al
i
(section) /y (lot number)(J (grave number)
8 Name of Sexton or Person in C of Premises
z (to "``"I
prase print/
al Signature Title (let/A <
DOH-1555(07/18)p 1 of 2
• ,„r rt
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
,
Pine View Cemetery Representing the funeral home named l on burifai pertnit
Official Funeral Directors Reg.or License#