MacDavid, Elsa S iiii:\,;,
NEW YORK STATE DEPARTMENT OF HEALTH ----, Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Elsa S.MacDavid Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/08/2022 93 Years War or Dates
Place of Death Hospital,Institution or
2
Z City,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing
ill
W Manner of Death ❑x Natural Cause Accident ❑Homicide Suicide illUndetermined ❑Pending
fl Circumstances Investigation
It! Medical Certifier Name Title
CI Jennifer Donovan DO
Address
152 Sherman Ave,Queensbury Town,New York 12801
DeaRth Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 189
Burial Date Cemetery,Crematory or Facility Name
12/13/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
ORemoval Date Place Removed
and/or and/or Held
N Hold Address
n
aL Date Point of
U)❑Transportation Shipment
a by Common
Carrier Destination
nDisinterment
Date Cemetery Address
Date Cemetery Address
❑Reinterment
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
.- Remains are Shipped,If Other than Above
Address
IC
fL
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/13/2022 Registrar of Vital Statistics Carolnexkkgari Barb-er(EkctronicallySigned)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I— /)
Z Date of Disposition 121 I4 17 L Place of Disposition ,r u,k ram
iti
2 (address)
W
CC (section) 7 (lot number) (grave number)
8 Name of Sexton or Person in Charge of Premises " `- tt
Z Zilie se print/
W SignatureTitle 711 `. ` � I
DOH-1555(07/18)p 1 of 2
''6 90
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#