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Wrobel, Patricia Ellen
. . 4 NEWYORK STATE DEPARTMENT OF HEALTH �zb� Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patricia Ellen Wrobel Female Date of Death Age If Veteran of U.S.Armed Forces, 03/07/2020 58 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 , Death Certificate Filed District Number Register Number City,Town orViRage Glens Falls 5601 116 'k ❑Burial Date Cemetery,Crematory or Facility Name 03/09/2020 Pine View Crematory ;_ ❑Entombment Address FXJ Cremation Queensbury Town,New York ❑Donation ❑Removal Date Place Removed and/or and/or Held Hold Address Date Point of ❑Transportation Shipment by Common Carrier Destination ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address ` 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address a w a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/09/2020 Registrar of Vital Statistics &bertAndrew Curtis(Electronicady Signed (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: Date of Disposition 1C?/ Place of Disposition 1 (address) M (section) (/otnumber) (grave number) Name of Sexton or Person in Ch e of Premises L L tvS (please print) 77 Signature Title L(crt�dC� DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 3 4 0 3 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#