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Yattaw,Mary Ellen 4111) tt 577 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital.Records Name First Middle Last Sex Mary Ellen Yattaw Female Date of Death Age If Veteran of U.S.Armed Forces, 06/26/2023 83 Years War or Dates F— Place of Death Hospital,Institution or Z City,Town or Village Syracuse Street Address 221 Conklin Avenue,Syracuse,New York 13206 W Manner of Death Natural Cause Accident Homicide Suicide FlUndetermined 7 Pending W I—I U Circumstances Investigation W Medical Certifier Name Title 0 Stephanie Coglitore NP Address 100 Malta Lane,North Syracuse Village,New York 13212 Death Certificate Filed County of Onondaga District Number Register Number City,Town or Village 3300 2745 ElBurial Date Cemetery,Crematory or Facility Name 06/29/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 Q. Date Point of Cl) Transportation p by Common Shipment Carrier Destination oDisinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/28/2023 Registrar of Vital Statistics 9Kicke(Ce ffignano(ECectronicalry Signed) (signature) District Number 3300 Place County of Onondaga I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition l30�'1. Place of Disposition 1' J—. � _ 2 (address) W Zriritt Ncc (section) (lot number) (grave number) SName of Sexton or Person in Charge of misesZ . ft /31se print) W Signature Title ii►`m)&l ire DOH-1555(07/18)p 1 of 2 111 Fir ` i a Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named ok burial permit Official Funeral Directors Reg.or License# `