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Gokey,Patricia Ann NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patricia Ann Gokey Female Date of Death Age If Veteran of U.S.Armed Forces, 04/09/2020 82 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 9 Patton Drive,Queensbury Town,New York 12804 W Mannerof Death Natural Cause Accident ❑Homicide Suicide Undetermined Pending U Circumstances Investigation WG Medical Certifier Name Title Christopher Mason DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 66 ©Burial Date Cemetery,Crematory or Facility Name 04/14/2020 St.Alphonsus Cemetery Entombment Address ❑Cremation Queensbury,New York Donation z Removal Date Place Removed and/or and/or Held ~ Hold Address N O O. Date Point of W Transportation Q by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Otherthan Above Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/13/2020 Registrar of Vital Statistics CaroCtnexfdegard BarAer(Ekctro,7 aLySy egJ (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: i- } Z Date of Disposition Z� Place of Disposition S� _ l ,hG 4 j�,' Ct)'t,c, �,lnctnS t„ W � (a dress/ W (section/ of num r/ (grave number) Name of Sexton or Persg#jn Charge of Premises V- Z (ptease print) W Signature A I,- Title DOH-1555(07/18)p 1 of 2