Paquette, Patricia NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Patricia Anne Paquette Female
Date of Death Age If Veteran of U.S. Armed Forces,
`' 05/06/2018 63 Years -
War or Dates
µ: Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
0. Manner of Death Natural Cause 0 Accident 0 Homicide 0 Suicide El Undetermined 0 Pending
Circumstances Investigation
Medical Certifier Name Title
Farhana Kamal MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 221
❑Burial Date Cemetery or Crematory
05/08/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
, r❑Removal and/or Held
and/or Address
Hold
f/)
Date Point of
Q Transportation Shipment
ref by Common Destination
Carrier
Disinterment Date Cemetery Address
0 Reinterment
Date Cemetery Address
Permit Issued to Registration Number
_-t Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
01 Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Of
11
re
Permission is hereby granted to dispose of the human remains described above as indicated.
I Date Issued 05/07/2018 Registrar of Vital Statistics Men A Curtis(E(ectronica((ySigned)
(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:
aDate of Disposition S if (it Place of Disposition F,,,u w C...,,"or -d
il (address)
(section) (lot number) (grave number)
12. Name of Sexton or Person in Charge of Premises 14,4144r Jo-41-
(plase print)
Lg. Signature (ill - Title AzOmt -
(over)
DOH-1555(02/2004)