Wright, Patrick t ' NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Patrick John Wright Male
Date of Death Age If Veteran of U.S. Armed Forces,
5/24/2018 75 War or Dates
Place of Death Hospital, Institution or
• City, Town or Village Glens Falls Street Address 48 Grant Ave
IU
O Manner of Death ❑X Natural Cause n Accident n Homicide ❑Suicide n Undetermined ❑Pending
Circumstances Investigation
w Medical Certifier Name Title
a Dr Reeves,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register umber
City, Town or Village Glens Falls,NY 5601 •oZ7
Ni Burial Date Cemetery or Crematory
May 31,2018 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z n Removal and/or Held
and/or Address
E Hold
O Date Point of
O.
• 0 Transportation Shipment
p by Common Destination
Carrier
C Disinterment Date Cemetery Address
(�Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
F- Remains are Shipped, If Other than Above
▪ Address
dC
W
a. Permission is hereby granted to dispose of the human remains d scribed bo`' indicated.
Date Issued OJT. /4* Registrar of Vital Statistics �G�
_ (signature)
District Number S60/ Place 61 ✓'h` % ,t-y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
UJ• Date of Disposition 5/31 /201 place of Disposition Pi nP view Ceme�de�r s)Queensbury
W Erie 17-H 1
(section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises Connie Coed ert
Z (please print)
W
Signature Title Cemetery Superintendent
(over)
DOH-1555(02/2004)