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Bartlett, Patricia NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section _'• Burial - Transit Permit Name First Middle Last Sex Patricia Frances Bartlett Female Date of Death Age If Veteran of U.S.Armed Forces, 411 7 /12/2018 77 yrs. War or Dates No Place of Death Town o f Hospital, Institution or City, Town or Village Ticonderoga Street Address 28 Hi gh 1 and Street . Manner of Death i Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined El Pending Circumstances Investigation Medical Certifier Name Title Kathleen P. Huestis M.D. Address 102 Race Track Road, Ticonderoga, NY 12883 Death Certificate Filed Town of District Number Register Number City, Town or Village T i c nn r1p r nga 1 5 6 4 2 7 ><<s❑Burial Date Cemetery or Crematory I. ❑Entombment 7/1 7/2.01 8 Pine View Crematory Address iiil ©Cremation Queensbury, New York Date Place Removed ❑Removal and/or Held .s and/or Address = Hold Vil Date Point of Transportation Shipment .5 by Common Destination - Carrier ❑Disinterment Date Cemetery Address ❑RRII. einterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Wilcox & Regan funeral home 01 821 `'- Address 11 Algonkin St. , Ticonderoga, NY 12883 IIName of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 2 Address fk Permission is hereby granted to dispose of the human re ins described abov as indicated. Date Issued 7/1 5/201 8 Registrar of Vital Statistic A cJ* ,(,--2 i " (signatur¢� l District Number IS(..pL f Place i/,1,,y-ier.6q� I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: iii 1 I I Place of Disposition Date of Disposition � �) � p PL.) L(c%-lOr'.., a (address) jj 14 (section) l(lot number) ! (grave number) flName of Sexton or Person in Charge of Premises f of .i'i _,_`j t'04f Z (ple1se print) ii t Signature Title t (over) DOH-1555 (02/2004)