Donaldson, Joyce J.J �� i j 0I
NEW YORK STATE DEPARTMENT OF HEALTH •• • \ __ _ Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Joyce Donaldson Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/27/2022 91 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Elizabethtown Town Street Address Elizabethtown Community Hospital
W• Manner of Death
a Natural Cause Accident El Homicide OSuicide Undetermined ❑Pending
Ill
U Circumstances Investigation
GMedical Certifier Name Title
Pasqualino Caputo 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 86
Burial Date Cemetery,Crematory or Facility Name
10/30/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
O. Date Point of
t/) Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
0 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
H Remains are Shipped,If Other than Above
$ Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/27/2022 Registrar of Vital Statistics fanet E.Cross(Elect>nniur/1'5gned)
(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:
•
Date of Disposition 10131 I'ZZ .ace of Disposition _ u ham_
2 -1
W
U)
Q (section) ) t (iat nu r/ - (grave number)
• Name of Sexton or Person in Premise G' n , J
Z / i rpr'rase int/
W Signature _ Title _. C tP M'+'p
V
DOH-1555(07/18)p 1 of 2
{ . _t ::. 1..A36
Public Health Law Sec. 4145(2b)
Receipt
1
Human remains of delivered on , 20
Pine View Cemetery Representing the;funeral home named on burial permit
Official Funeral Directors Reg.or License#