McCarthy, Patricia a ,
NEW YORK STATE DEPARTMENT OF HEALTH -Vital Records Section Burial Transit Permit
tiii Name First Middle Last Sex
Patricia McCarthy Female
Date of Death Age If Veteran of U.S. Armed Forces,
01 / 18 / 2018 72 War or Dates N/A
Place of Death Hospital, Institution or
WCity, Town or Village Milton Street Address Gateway House of Peace
p Manner of Death®Natural Cause �Accident �Homicide �Suicide Undetermined �Pending
ua Circumstances Investigation
Eti Medical Certifier Name Title
Q Edward M. Liebers MD
Address
3 Care Ln #300, Saratoga Springs, NY 12866
Death Certificate Filed District Number `-'I .t i Register Number 6
City, Town or Village Milton
gill nBurial Date Cemetery or Crematory
O1 / 18 / 2018 Pine View Crematory
iYi uEntombment Address
Mli LNCremation Queensbury, NY
` Date Place Removed
Z❑Removal and/or Held
Q and/or Address
tt Hold
0
q Date Point of
Q Transportation Shipment
a by Common Destination
iiiit Carrier
Disinterment Date Cemetery Address
ft
Q Reinterment Date Cemetery Address
i;i>< Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
ra
iiiii Address
402 Maple Ave., Saratoga Sp., NY 12866
`'` Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
# Address
t
1u
Permission is hereby granted to dispose of the human reps described ove' s indica
igi Date Issued 1 Iaal( li3 Registrar of Vital Statisti4r 111 ' '
(signature)
iiilig District Number 1--\ w( Place Milton , New York
#- I certify that the remains of the decedent identified above were disposed of in accordance' with thispermit on:
f V e,.. L .
ill Date of Disposition ����i(t Place of Disposition ,M �,..
1 E (address)
0
it (section) J(lot numbe (grave number)
0 Name of Sexton or Person ip Charge of Premises - t"rtI 41
Z
(pl ase print) -
Signature 6 ' ' 4 Title itu
(over)
DOH-1555 (02/2004)