Sullivan, Patricia r l 14
NEW YORK STATE DEPARTMENT OF HEALTH ,,
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
PATRICIA G. SULLIVAN Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 10, 2006 80 War or Dates
Place of Death Hospital, Institution or
City, Town or Village City of Glens falls Street Address Glens Falls Hospital
iiiManner of Death Natural Cause 0 Accident D Homicide El Suicide riUndetermined ri Pending
tii Circumstances Investigation
:W Medical Certifier Name Title
14 R. Sponzo, MD
Address
Glens Falls, NY
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls, NY 5601
is OBurial Date Cemetery or Crematory
OEntombment March 13, 2006 Pine View Crematory
Address
remation Queensbury, NY
Date Place Removed
Z Removal and/or Held
2 ❑and/or
F; Address
Cl)
Hold
0 Date Point of
d` Transportation Shipment
a by Common Destination
Carrier
g. El Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton—Healy Funeral Home 01682
i Address
407 Bay Rd Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Z Address
ILI
: Permission is hereby granted to dispose of the human remains described above s in ' at d.
Date Issued 3/12/2006 Registrar of Vital Statistics ‘ i 'Ltyv
signature)
District Number 5601 Place City of Glens Falls, NY 12801
;.,;:::: I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
ILI Date of Disposition 3_1,3 aG Place of Disposition /j'/I/Ft/i Lei ed1ZfAii4td iq_ )' c
(address)
Ili
to
cc (section) (lot nuT�ber) (grave number)
Ct
ti Name of Sexton or Person in Charge of Premises Cs-1q �z.,� �R-�'t4
CRejo ' / a Tint)
L
. Signature � � Title 2
(over)
DOH-1555 (02/2004)