Thorne, Patti It
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
"" Name First Middle Last Sex
Patti Ann Thome Female
,, Date of Death Age If Veteran of U.S. Armed Forces,
' 03/30/2018 82 Years War or Dates
Place of Death Hospital, Institution or
- City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ri❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Mathew Varughese DO
Address
100 Park St,Glens Falls,New York 12801
.. Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 163
®Burial Date Cemetery or Crematory
04/05/2018 Pine View Cemetery
"` ❑Entombment
Address
. 1-1
: ❑Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
h❑Disinterment
Date Cemetery Address
❑Reinterment
Date Cemetery Address
Permit Issued to Registration Number
• Name of Funeral Home Regan Denny Stafford Funeral Home 01443
• Address
wv 53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Y.
4i7,4Date Issued 04/02/2018 Registrar of Vital Statistics 106ertA Curtis(E(ectronica((ySigned)
(signature)
4, District Number Place
5601 Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 4/5/2 01 8Place of Disposition p 1 ne V i pw Cemetery 21 Quaker Rd_ Qsby
(ddress)
New Kenesaw 8-B 1
(section) (lot number) (grave number)
a.
• Name of Sexton or Person in Charge of Premises___ Connie Goedert
(please print)
Signature, - .< 4.4..--
Title Cemetery Super; n1-endPnt
(over)
DOH-1555(02/2004)