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Nelson, Maria Elena ' 11(.1,........5 .ft 57s- NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Maria Elena Nelson Female Date of Death Age If Veteran of U.S.Armed Forces, 12/05/2023 80 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 10 Hilton Drive,Moreau Town,New York 12803 p Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation WMedical Certifier Name Title 0 Sean Campanie NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 69 ElBurial Date Cemetery,Crematory or Facility Name 12/08/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York DDonation ZZ❑Removal Date Place Removed and/or and/or Held ~ Hold Address • N 0 LL Date Point of co Transportation p by Common Shipment Carrier Destination EDisinterment 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 .. Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/08/2023 Registrar of Vital Statistics Brenda 5futter(Electronicaffy Signed) (signature) District Number 4562 Place Town Of Moreau I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition /2—?aZ3 Place of Disposition P e,,J 64 FcQ 2 (address II N CC (section) (lot number) (grave number) SName of Sexton or Person in Cha of P m' es eAfMp.4) (please` riot/ z W Signatures/9"`` Title t 401.— DOH-1555(07/18)p id 2 i , + Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Funeral Directors Reg.or License#