Patrick, Linda NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - TransitIt ermit
Name First Middle Last Sex
w
Linda Stanton Patrick Female
,r,f Date of Death Age If Veteran of U.S.Armed Forces,
ti June 26,2016 72 War or Dates n/a
'r'I Place of Death Hospital, Institution or
City, Town or Village Queensbury,NY Street Address 11 Owen Ave
Manner of Death fJ Natural Cause ElAccident ❑Homicide ElSuicide ❑Undetermined n Pending
Circumstances Investigation
Medical Certifier Name Title
r?, Address
iif
`` , Death Certificate Filed District Number Register Number
): City, Town or Village Queensbury,NY 5657 'la
❑Burial Date Cemetery or Crematory
June 28,2016 Pine View Crematorium
❑Entombment Address
®Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
ZZ ❑Removal and/or Held
and/or Address
g
Hold
N
0 Date Point of
y ❑Transportation Shipment
ci by Common Destination
Carrier
El Disinterment Date Cemetery Address
❑Renterment Date Cemetery Address
``
i��j Permit Issued to Registration Number
r' Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road,Queensbury, NY 12804
, Name of Funeral Firm Making Disposition or to Whom
`" Remains are Shipped, If Other than Above
Address
15
Permission is hereby granted to dispose of the human remains described above as indicated.
' i' Date Issued lc-a-'1— ?bile Registrar of Vital Statistics '-eoZA- - A c k ,
(signature)
r`' District Number 5657 Place Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 7 11 1 l j , Place of Disposition Rat 0 i✓
W (address)
0 (section) (loc number) (grave number)
pName of Sexton or Person in Charge of Premises l h"r L
Z QIease print)
IL /Signature L� .2 Title TrikkJ '
(over)
DOH-1555(02/2004)