Loading...
Lortie, Elizabeth Ann iii- L.— NEW YORK STATE DEPARTMENT OF HEALTH Burlap - Transit Permit Bureau of Vital Records Name First Middle Last Sex Elizabeth Ann Lortie Female Date of Death Age If Veteran of U.S.Armed Forces, 05/22/2023 90 Years War or Dates ZPlace of Death Hospital,Institution or W City,Town or Village Queensbury Town Street Address 47 Meadowbrook Road,Queensbury Town, New York 12804 p Manner of Death El Natural Cause Accident El Homicide ESuicide Undetermined ❑Pending W C.) Circumstances Investigation CMedical Certifier Name Title Thomas Coppens MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 79 Burial Date Cemetery,Crematory or Facility Name . 05/23/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed F and/or and/or Held N Hold Address 0 Ct. Date Point of U)❑Transportation p by Common Shipment Carrier Destination ODisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address Q W LL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/23/2023 Registrar of Vital Statistics Caroline 9fi&rfegardeBarber(ECectronica1tySigned) (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— W 'roc Date of Disposition 3-(ZS'(13 Place of Disposition v �ho�2 (address/ W U) CC (section/ A (lot number) _ (grave number) Name of Sexton or Person in Charge of P ises A r^ L. f/►.4 z (pt ase pAntr W Signature Title �'�^'qTo� DOH-1555(07/18)p 1 of 2 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#