Eggleston, Patricia NEW YORK STATE DEPARTMENT OF HEALTH 59 1 11 I
Vital Records Section Burial - Transit Permit
,, Name First Middle Last Sex
Patricia Eggleston Female
Date of Death Age If Veteran of U.S. Armed Forces,
November 29, 2011 66 War or Dates
iPlace of Death Hospital, Institution or
City, Town or Village Glens Falls _ Street Address Glens Falls Hospital
di
ll Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
11f Circumstances Investigation
g Medical Certifier Name Title
gt
Address
Nd,
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls,NY 5601 Jr-/I
❑Burial Date Cemetery or Crematory
November 30, 2011 Pine View Crematory
❑Entombment Address
0 Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
0 and/or Address
H Hold
N
0 Date Point of
N I I Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
'3;*3 Permit Issued to Registration Number
itl Name of Funeral Home Regan& Denny Funeral Home 01443
::, Address
53 Quaker Road, Queensbury,NY 12804
a;; Name of Funeral Firm Making Disposition or to Whom
g Remains are Shipped, If Other than Above
g: Address
Permission is hereby granted to dispose of the human remains descri ed above s i i a ed.
pa; Date Issued /% 40/-z !/ Registrar of Vital Statistics
signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z 'I
W Date of Disposition Dkc 74141 Place of Disposition RoV14-) ireaclDtiv--
2 (address)
W
ft (section) A (lot numb (grave number)
pName of Sexton or Person in Charge of Premises 404, 0.10ttk
ZAi.... (please print)
Signature
W Title v g#14-( (
(over)
DOH-1555(02/2004)