Pettys, Patricia M. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Patricia M.Pettys I Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/30/2019 81 Years War or Dates
II.— Place of Death Hospital,Institution or
WCity,Town or Village Malta Town Street Address 10 Hearthwood Drive,Malta Town,New York 12019
p Mannerof Death Natural Cause Accident Homicide Suicide El Undetermined Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
Marianne Mustafa MD
Address
6 Medical Park Drive 208,Malta Town,New York 12020
Death Certificate Filed District Number Register Number
City,Town or Village Malta 4560 _ 1
Burial Date Cemetery,Crematory or Facility Name
01/03/2020 Pine View Crematory
Entombment Address
RICremation Queensbury Town,New York
Donation
z Removal Date Place Removed
and/or and/or Held
H N Hold Address
O
G. Date Point of
U) Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
W
I' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/03/2020 Registrar of Vital Statistics ftnniferAfarie.4f'okwx(<Electronicad Sigaed)
(signature)
District Number 4560 Place Malta, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W
Date of Disposition ,,/_ ZDz�, Place of Disposition Q (,t
LU (addre s/
W
N (section) (!ot nu er/ (grave number)
cc
0 Name of Sexton or Person in arge of Pr ises E`
(please print)
Z
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 013200
Receipt
Human remains of i delivered on r i , 20
t
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Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#