Loading...
Patnode, James Richard NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James Richard Patnode Male Date of Death Age If Veteran of U.S.Armed Forces, 04/12/2020 75 Years War or Dates 1966-1970 F Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 6 Fairwood Drive, Queensbury Town, New York 12804 pMannerof Death ©Natural Cause Accident Homicide ❑Suicide Undetermined Pending C.) Circumstances Investigation W Medical Certifier Name Title John Sawyer MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Villa a Queensbury 5657 67 ©Burial Date Cemetery,Crematory or Facility Name 04/17/2020 Pine View Cemetery Entombment Address Cremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 to Transportation Date Point of tom] by Common Shipment Carrier Destination 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 Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/14/2020 Registrar of Vital Statistics CarohneYfifdegarde Barber(EfectronicaCCySigner) (signature/ District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed fin accordance with this permit on: Z W Date of Disposition 4,/T zOl U Place of Disposition (address) N (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises �G�N�e Z (pleaiFeprin# W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 010378 Receipt Human remains of - k`r'' i ?_ delivered on- 20 %\ 1 � - t l e View Ceme�Ie Representing the funeral home named on burial permit Official 1 Funeral Directors Reg.or License# Patnode NAME James Richard Patnode Age: 75 Lot Owner: Marcie Patnode Lot# 33G Seneca Grave# 1 Case: Full Concrete Died: 4/1 2/2 0 2 0 Interred:4/1 7/2 0 2 0 Funeral Home: Singleton Sullivan Potter Cemetery: pine View Cemetery