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Lafreniere, Patricia Claire NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patricia Claire Lafreniere Female Date of Death Age If Veteran of U.S.Armed Forces, 01/01/2020 45 Years War or Dates II.. Place of Death Hospital,Institution or W' City,Town or Village Glens Falls Street Address Glens Falls Hospital Q Manner of Death ©Natural Cause Accident ❑Homicide ❑Suicide ❑Undetermined El Pending (Wj Circumstances Investigation QW Medical Certifier Name Title Terry Comeau Coroner Address 1400 St Route 9,Lake George Town,New York 12845 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 4 Burial Date Cemetery,Crematory or Facility Name ❑ 01/03/2020 Pine View Crematorium Entombment Address 0 Cremation Queensbury Town,New York ❑Donation OZ ❑Removal Date Place Removed and/or and/or Held N Hold Address O (L Date Point of Ci) Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address i Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition orto Whom _ Remains are Shipped,If Other than Above 2 Address X W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/03/2020 Registrar of Vital Statistics P,96ertAmfrew Curtis(ECectronicaCCySigned) /signature/ District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition jp Place of Disposition 2 (address/ W cc N /section/ (lot number/ /grave number) aName of Sexton or Person in Charge of Pre ises n� Z ase print) W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013206 Receipt Human remains of delivered on , 20<'� r Pine Mew Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#I