Loading...
Lafferty, Patricia NEW YORK STATE DEPARTMENT OF HEALTH 1 1 Vital Records Section Burial - Transit Permit --- Name First Middle Last Sex Patricia Ann Lafferty Female Date of Death Age If Veteran of U.S. Armed Forces, November 30, 2016 53 War or Dates 1-- Place of Death.., Hospital, Institution or W` City, Town or(Village j Hudson Falls Street Address 15 Juckett Drive Manner of Death Natural Cause ❑ Accident ID Homicide El Suicide ElUndetermined ri Pending Circumstances Investigation ILI Medical Certifier Name Title CI Michael Fuller, M.D Address 100 Park Street Glens Falls, NY 12801 Deat ificate Filed J District Nu:"hPr Register Number City(Towner Village /.,r r")� =) y:- V'(--�/ 5-7 J, J.-9 ❑Burial Date Cemetery or Crematory December 1, 2016 Pine Vew Crematorium Entombment Address ©Cremation Queensbury,NY 12804 Date Place Removed Removal "`• and/or '`�-- and/or Held 1.-: Hold Address ICO Date Point of Transportation Shipment by Common Destiny _ny Ci Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Y Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom 1--„, Remains are Shipped, If Other than Above Address ix w 0` Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued !d- /--2 o/h Registrar of Vital Statistics ,, ( , ), a (signature) District Number 7 � Place ,� �,Q�,` a Q01 I certify that the remains of the decedent identified abovl were disposed of in accordance with this permit on: ur Date of Disposition 121 2016 Place of Disposition Queensbury,NY 12804 ? (address) LU '.... iX (section) (lot number) (grave number) O Name of Sexto P o in Charge of Premises - IA, it Gi.-Yt. 6G NZ C.,vac e z,- ,,// (please print) Al Signature 0 -- Title G re-sno (over) DOH-1555 (02/2004)