Tanguay, Patricia NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Patricia A. Tanguay Female
ir. Date of Death Age If Veteran of U.S. Armed Forces,
September 10,2016 83 War or Dates
',,.. Place of Death Hospital, Institutiordirondack Tri-County Health Care
Z.e City, Town or Village Johnsburg Street Address Center
ciManner of Death X Natural Cause I I Accident I I Homicide Suicide Undetermined Pending
1U= Circumstances Investigation
Medical Certifier Name Title
James Hindson Dr.
=:1 Address
Main St.,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
:' City, Town or Village Johnsburg 5655 27
❑Burial Date Cemetery or Crematory
❑Entombment September 13, 2016 Pine View Crematory
Address
❑x Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F- Hold
N
0 Date Point of
NTransportation 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
F Name of Funeral Firm Making Disposition or to Whom
l Remains are Shipped, If Other than Above
'ALL Address
X-
14
-° Permission is hereby granted to dispose of the human re described a ve as indi ted.
i Date Issued - I ILO. Registrar of Vital Statistics ((--)
nature)
' District Number 5655 Place Johnsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition l(r`t(IL Place of Disposition fecd,e,1 ��a„ctbr_.-
w (address)
N
QfY (section) /y (lot number) (grave number)
Name of Sexton or Person in Charge of Premises L/�r..ri� Si4dlt'
Z /� please print)
W ` � r&
Signature Title
(over)
DOH-1555(02/2004)