Spinelli, Jane (2) \O33
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Jane Spinelli Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/29/2022 87 Years War or Dates
1., Place of Death Hospital,Institution or
111 City,Town or Village Moriah Town _ Street Address 2779 Center Road,Moriah Town,New York 12961
p Manner of Death lNaturalCause Accident 0Homicide Suicide ['Undetermined ❑Pending
0 Circumstances Investigation
W Medical Certifier Name Title
0 Melanie Duerr NP
Address
47 Tom Phelps Lane,Mineville Hamlet,New York 12996
Death Certificate Filed Town Of Morah District Number Register Number
City,Town or Village 1558 32
EiBurial Date Cemetery,Crematory or Facility Name
12/30/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
f- Hold Address
(n
0
it]. Date Point of
(0❑Transportation Shipment
p by Common
Carrier Destination
Disinterment Date Cemetery Address
El
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 Finn Making Disposition or to Whom
H Remains are Shipped,If Other than Above
g Address
CC
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/29/2022 Registrar of Vital Statistics 1Zose5ff,French('EYectmaictlh'Sgned)
(signature)
District Number 1558 Place Town Of Moriah
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I^
WDate of Disposition /Z-3 p_Z'e z Place of Disposition P til ✓'t'-t.) C -iT1 d ess4
2
W
NCC (section) (lot numb -1 (grave number)
0 Name of Sexton or Person in Ch a of Pre ses
(please print)
Ill Signature ri''r`7' Title of 4D�
DOH-1555(o7/t8)pi of 2
E1 `r 4
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#