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Scalero, Elizabeth Jane . L 41 17 c NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Elizabeth Jane Scalero Female Date of Death Age If Veteran of U.S.Armed Forces, 12/01/2023 91 Years War or Dates "., Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc 11.1 p▪ Manner of Death �Natural Cause Accident Homicide Suicide ❑Undetermined Pending Circumstances Investigation W Medical Certifier Name Title n Nicole Humiston NP Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed Town Of Fort Edward District Number Register Number City,Town or Village 5755 101 Burial Date Cemetery,Crematory or Facility Name 12/04/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury,New York Donation o❑Removal Date Place Removed and/or and/or Held N Hold Address a U)❑Transportation Date Point of a by Common Shipment Carrier Destination Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address 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 IH Remains are Shipped,If Other than Above a Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/04/2023 Registrar of Vital Statistics Aimee G Mahoney(Electronically Signed) (signature) District Number 5755 Place Town Of Fort Edward I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH Z Date of Disposition 12 I s 173 Place of Disposition rjtiEt46%-) (E E 41gt0 LIih tu 2 (address) W CO CC (section) A (lot number (grave number) � GName of Sexton or Person in Charge of Preryises r as �.�,` �•t It Z / (p�ase print) ` Ili Signature Title `Of rn4 7t1 DOH-1555(07/18)p 1 of 2 ~i Zr .if 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#