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Patterson, Dawn NEW YORK STATE DEPARTMENT OF HEALTH` Vital Records Section Burial - Transit Permit t Name First Middle Last Sex Dawn Patterson Female Date of Death Age If Veteran of U.S. Armed Forces, April 27,2017 49 War or Dates Place of Death Hospital, Institution or City, Town or Village V/O Lake George Street Address 64 Chestnut Street ;p; Manner of Death Natural Cause Accident Homicide Suicide Undetermined x Pending lit Circumstances Investigation Medical Certifier Name Title Timothy Murphy Coroner Address 52 Haveland Ave.,Glens Falls,NY 12801 Death Certificate Filed District Number RegisteL,Number City, Town or Village V/O Lake George 5620 L ❑Burial Date Cemetery or Crematory Pine View Crematory Entombment Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z Removal and/or Held and/or Address H Hold Gn O Date Point of O. Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander-Baker Funeral Home 00037 Address 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above „M Address tt3 Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 65/C(/261 7 Registrar of Vital Statistics Aa/V2_0.4.„14_,—() (signature) District Number c‘o 2n Place C uP C'`(15 b LtY y I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition '&(I , fl 'Place of Disposition 'llni u1•�,. r! •"�, W (address) Cl) O (section) /4 j (lot number) (grave number) • Name of Sexton or Person in Charge of P emises // 31 �- v. `Z (pl ase print) Signature 6.1 Title M' I1 (over) DOH-1555 (02/2004)