Klingbeil, Patricia h4
NEWYORK STATE DEPARTMENT OF HEALTH t r Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last FFe
Patricia Klingbeil le
Date of Death Age If Veteran of U.S.Armed Forces,
04/12/2020 60 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Fort Edward Town Street Address 2358 State Route 4, Fort Edward Town,New York 12828
w Mannerof Death Undetermined Pending
W a Natural Cause Accident Homicide ❑Suicide
Circumstances Investigation
U
W Medical Certifier Name Title
0 John Delmonte MD
Address
3 Care Lane,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Fort Edward 5755 28
Burial Date Cemetery,Crematory or Facility Name
04/14/2020 Pine View Crematory
Entombment Address
X Cremation Queensbury Town,New York
Donation
z Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
O
d Date Point of
() FiTransportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
jo 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 Otherthan Above
Address
Ir
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 /�imeeMw oney(Ek--tro,7kad Stgtrea)
(signature)
District Number 5755 Place Fort Edward, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
zur'/� 0•—
W Date of Disposition l �?� Place of Disposition
2 (address)
W
N (section) tot number/ (grave number)
M
13 Name of Sexton or Person in Char of Premises
Z (plea print/
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) K 13 5 0
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named t npurial permit
Official Funeral Directors Reg.or License# t