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Patnaude, Elsa NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Biostatistics -Vital Records Section 10 Name First Middle Last Sex 12. �; ............ .......M. .... P . u e.:.. ._ ...___. ... _._........Female.. ... Date of Death Age If Veteran of U.S.Armed Forces, War or Dates �. .:..an a.r:. .:.:.26:,:.19.8.8::. .:.:: .:..:..'�..0..................:......................................... .N.Q .::_:....................:..:........................ .............: Pace oDeth Hospital, Institution or NY. 12020 City,Town or Village Street Address ... .............::::::. : :::..:.::::dawn:.:.©:�:.:�a.laa::::.:._:::::::::::::::::._::::::.::..:...::::::::.:.:::.::::::::::::a�D�..�.:.Arnaaci.:::R.o.ad:,.B.al.lat..ox�:. SpF G Cause of Death Me ica�Certifior Name Title :::::::.:::.:::::.:.:::::::::._:::::..George:.:J.o.11. :.:::::::.::::.:::......:::::::.:.:::::::::::.::::::::.:::.:.::::MD. ..::.._:::..::::.:_:. Ad Tess y 2.:. vr le..-Street...............:::Sarat. .��.a....S:pr _s.in :.N.Y:.::::::::: :::.:::::. :::::: ::.::::.:: :::::::::.::::::::: ::..:::::::::Death Certd ate Fird :: Disfrictt Nu er Register Number iiiiliiii City,Town or Village �,© Cf MA1't:A '$<4"6.d Date Cemetery or Crematory ❑Burial January 27,1988 Pine.....VieW..:..Cr..ema.t:ory........ ElCremation Address Town of Queensbury,New York Z Date Place Removed o_ ❑ Removal and/or Held and/or Hold .....A:::: F" Address ... •�, Date Point of cn ❑Transportation by Shipment G Common Carrier Destination .....:: ID Disinterment Date Cemetery Address..........::...:........:.:.::::...................... ...:...................................... El Reinterment Date ,...Cemetery Address.....................::...................... .:...................... ..............::.:.........:.: i. Permit Issued to Registration Number Name of Funeral Fir »::>::> �4d...11a.a®.::J.11 ,.::::B:urke.:::&:::.S.on Address:::::................... iiiiiiiiiii ....62..8....NNarth::.Brodway,S.arat.oga„..-,pr. ame o Funeral Firm makingDisposition or t m:: Remains are Shipped, If Other than Above.:::.::::.::::::::::::::::::...:. .:.........._......._............................... Address AU 34 Permission is hereby granted to dispose of the dead an remains de cribed above as indicated. gi Date Issued /-074 Registrar of Vital Statistics ,A ' 6/ imi: (signature) ld-T` t District Number 17'4-6 0 Place -c ere .7/G� �' � certify that the remains of the decedent identified above disposed of in accordance with this permit on: w" Disposition /- 7- Disposition ,' `v v/;k� ���42,ra/? ' M Date of g�Place of (� 2' (address) LU CC (section) (lot number) (grave number) p• Name of Secton or Perso in Charge of Premises ��1",/ .P /d T/rd./../ Z: lease print) ! � At Signature Title /`A /e��d/Cy /51 si / ' DOH-1555(9/86)p 1 of 2(formerly VS-61)