Higgins, Patricia e��
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Patricia Jean Higgins Female
Date of Death Age If Veteran of U.S. Armed Forces,
August 24,2017 68 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Hartford Street Address One East Street
' Manner of Death Undetermined Pending
X Natural Cause Accident Homicide Suicide
W° Circumstances Investigation
w Medical Certifier Name Title
0. Sarah Walton
Address
3767 Main Street,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
H City, Town or Village Hartford 5759
❑Burial Date Cemetery or Crematory
Entombment August 25,2017 1 Pine View Crematory
Address
0 Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
U)
0 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
Address
cK
AO
Permission is h reby ranted to dispose of the human ins describe a�i ve as indicated.
Date Issued e- ,P-5 l) Registrar of Vital Statistics
. (signatur )
District Number 5759 Place Hartford
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 5')1gJn Place of Disposition fit,{).-,, gal%01.."."
W (address)
N
OC (section) (10 number) (grave number)
pName of Sexton or Person in Charge of Premises ri,,J .&r -
Z (please print)
w Signature 4 / Title H mit-b
(over)
DOH-1555 (02/2004)