Mann ,Patricia M. NEW YORK STATE DEPARTMENT OF HEALTH , BUrlal - Transit Permit
Bureau of Vital Recores
Name First Middle Last Sex
Patricia V.Mann Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/2�/2020 1 78 Years War or Dates
L ` a'��" ' `��"t" Hospital,Institution or
of 6v idge
W=----- Albany Street Address Albany Medical Center Hospital
-
p Manner of Death ® Natural Cause Accident Homicide ❑Suicide Undetermined Pending
U'— Circumstances Investigation
- Title
Donald Tessitore NP
Address
r
ry •. Scc;La ::bany,New York 12208 j
District Number Register Nun:be!
r-e 4,oany 1 0101 0943
r 1' te Cemetery,Cremata?y or Facility Name
202G Pine View Crematory
-d r��s
r E
-, 1,< i;oury Town,New York
�- P!aze Removed
an'oor Held
�- !rate Point of
410nation r
Cemetery Address
alp Cemetery Address
- -.--•-
_ Registration Number
uneral Home Inc 00211
E;,x 500. -ake Luzerne,New York 12846
1) —osition or to W`nom
C: Above
:by c=,-:;rated to dispose of the human remains described above as indicated.
�`)20 Registrar of Vital Statistics Danielle S Gillespie(Electronically Signed)
- -- - -- (signatures
Place Albany, New York
t,:- -edent idIentitieL,above were dispwed of in accordance with this permit on;
A130LUO Place of Disposition
(address)
�- I,ri�•�//1 ((ot}nUU/Le/-f[`\ tly Igldvr uu/i7Url%
of P emises
(p ase print]
Title `��
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Y Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#