Harkness, Patricia NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Patricia A Harkness Female:.
Date of Death Age If Veteran of U.S.Armed Forces,
March 2, 1994 73 War or Dates
-,' Place of Death Hospital, Institution or
t City Town or Village Brunswick Street Address 983 Spring Avenue Ebctensiarn
00 Manner of Death 1=1 Natural Cause 0 Accident ❑Homicide El Suicide 0 Undetermined Pending
Circumstances Investigation
Lt# Medical Certifier Name Title
Q Edward G. MerzigI"ID.....
Address __
461Shaker Road, Albany, NY
Albany-
Death Certificate Filed District Number Register Number
City,Town or Village Brunswick 4151
Date Cemetery or Crematory
El Burial June 2, 1994 P��ew Cemet
Cremation Address
Glens Falls, NY
z Date Place Removed
O 0 Removal and/or Held
1 ' and/or Hold ::................::..:.
tr)
Address
O.
0 Date Point of
cn Transportation by
p Common Carrier Shipment
Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Firm Bryce Funeral Hcixe Inc. 00252
Address
276 Pawling Ave. Troy, NY 12180
#.-; Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
�:.....Address
..............
iXu
'CL3
Permission is hereby granted to dispose of the hunkan r ns ri a as indicated.
Date Issued 6/1/9 4 Registrar of Vital Sta ' los
ig ure)
i
District Number 4162 Place Town of Schodack
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I-,
W': Date of Disposition 6/2/94 Place of Disposition Pine View Cemetery Queensbury NY 12804
2< (address)
w Wah-Tah-Wah 589 5
co
(section
)( ) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises Rodney G. Moshe r
Z (please print)
w Signature ,,�}- fr Title Supt.
DOH-1555 (10/89) p. 1 of 2 VS-61