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Shippee, Patricia Joan � w NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patricia Joan Shippee Female Date of Death Age If Veteran of U.S.Armed Forces, 04/20/2020 84 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc p Mannerof Death ©Natural Cause Accident Homicide Suicide Undetermined Pending tL Circumstances Investigation WMedical Certifier Name Title Michael Miles MID Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 31 ❑Burial Date Cemetery,Crematory or Facility Name 04/21/2020 Pine View Crematorium Entombment Address lCremation Queensbury Town,New York ❑Donation Z Date Place Removed O R Removal and/or and/or Held A') Hold Address O d Date Point of to ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ❑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 Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/21/2020 Registrarof Vital Statistics Aimee Mahoney(ECectronicallySigned) /signature/ District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were dis of in accordance with this permit on: H Y ��eA,y ZI /�tec� l Z Date of Disposition 4/-2 2-Z02JPlace of Disposition I�� ) �k � �teQ b W address/ 2 W N (secti, /lot number/ (grave number/ Name of Sexton or Per Charge of Premises — l'�` '� VGvir►1G� Y' /please pnnrr W Signature Title DOH-1555(07/18)K1 of 2 Public Health Law Sec. 4145(2b) Y Receipt Human remains of ` delivered on , 20- Pine View Cemetery Representing the funeral home named pn burial permit Official Funeral Directors Reg.or License#