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Farrell, Patricia Ann I .. k s(3 NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patricia Ann Farrell I I Female Date of Death Age If Veteran of U.S.Armed Forces, 05/02/2020 1 62 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause Accident Homicide ❑Suicide ❑Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title Abigail Macomber PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 199 Burial Date Cemetery,Crematory or Facility Name 05/04/2020 Pine View Crematorium Entombment Address (l Cremation Queensbury Town,New York Donation ❑Removal Date Place Removed and/or and/or Held H N Hold Address a Date Point of Cl) ❑Transportation Shipment p by Common Carrier Destination El Disinterment Date Cemetery Address JE]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 i Remains are Shipped,If Otherthan Above Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/04/2020 Registrar of Vital Statistics 9Xg6ert Andrew Curtis(ECectronicaCfy Signed (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition E4 ITO Placeof Disposition W (address) 2 W CO) (section) /�(d num ed (grave number/ °C G 1, Name of Sexton or Person in C ge of Pre ' es r t° 4," 8 Z /pleas print/ W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20— Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# --,/