Szabo, Patricia . ti 33a
NEW YORK STATE DEPARTMENT OF HEALTH - 4 Burial - Transit Permit
Vital Records Section
▪ Name First Middle Last Sex
::: Patricia A. Szabo Female
: Date of Death Age If Veteran of U.S. Armed Forces,
.. May 3, 2015 73 War or Dates
' Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death 1X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Robert W.Sponzo
Address
:: Cancer Center, 102 Park St,Glens Falls,NY 12801
:•:: Death Certificate Filed District Number Register N tuber
ram: City, Town or Village Glens Falls 5601 � �
❑Burial Date Cemetery or Crematory
May 5,2015 Pine View Crematory
❑Entombment Address
❑x Cremation Quaker Road, Glens Falls,NY 12804
Date Place Removed
ZZ I I Removal and/or Held
and/or Address
Hold
Q Date Point of
O. Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
:::'. Permit Issued to Registration Number
Name of Funeral Home Regan& Denny Funeral Home 01444
Address
j , 94 Saratoga Avenue, South Glens Falls,NY 12803
..j Name of Funeral Firm Making Disposition or to Whom
E'`'`' Remains are Shipped, If Other than Above
Address
i
Permission is hereb granted to dispose of the human remains descri `ab�ve s i i ted.
��:` Date Issued 5t �.5— Registrar of Vital Statistics /�/�irr
d/ ' ‘ -
r:; � � signature)
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:. 'L District Number 5601 Place Glens Falls / / /aS)Dt'
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Place of Disposition 'ja ��
W Date of Disposition 118Jt5 P nc r--1 Os).-
2 (address)
W
CO
d' (section) J� (lot numb ) (grave number)
Q Name of Sexton or Person in Charge of Premises «r - &I'
Z ►(please print)
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Signature 4- Title f
(over)
DOH-1555(02/2004)