Morris, Patricia NEW YORK STATE DEPARTMENT OF HEALTH
t _- Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Patricia Ann Morris Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 12, 2015 76 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Street Address 1604 Route 9
Manner of Death Natural Cause 0 Accident El Homicide El Suicide � Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Glen Anderson,
Address
161 Carey Road Queensbury, NY 12804
Death Certificate Filed District Number Register Number
==-x Ci , Town or Village
®Burial Date Cemetery or Crematory
March 18, 2015 Pine View Cemetery
❑Entombment
Address
❑Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
. Removal and/or Held
,° and/or Address
Hold
f Date Point of
Transportation Shipment
by Common Destination
Carrier
Disinterment
Date Cemetery Address
':-_� Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078
Address
136 Main Street, South Glens Falls NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
.
Permission is hereby granted to dispose of the human r3mai scribed ov as indicated.
Date Issued ,a /�j/,�j Registrar of Vital Statistics ����
J f' etall 'g a re)
District Number g.0)_- Place S /(4
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I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
.., Date of Disposition 03/18/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
Uncas 1680 Sec 22 1
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises Connie L. Goedert
( ery leaseS
print)
Cemeuperintendent
Si nature- - ' .e Title
g V
(over)
DOH-1555 (02/2004)
ANGEL4
Lot No.. 1680-
Address 60 Main St., So. Glens Falls, N.Y. Section Nct. -
Owner Eric Vincent D'Angelo Plot Uncas
I-
bZ
Date 10/13/81
100 Superficial ft. @ $450.00
Location Bounded on the North by D'Angelo, East by Vacant, South by Vacant, West by Sahlke
Corner Posts y
t==
Remarks re cc(; cok),\ ly C Au-i-E• 40 7- /J /
Deed No. (and changes) 1680
Payment Record Paid in full 10/13/81
,--- .
Form No. 01
Record of Interments
1 5
Patri^ia Morris 3/18/2015
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NAME Morris, Patricia Ann
Age: 76
Cause: Natural
Lot Owner: Eric Vincent D'Angelo
Lot # 1680, Uncas
Grave # 1
Case # Concrete
Died: 3/12/2015
Interred:
3/18/2015
Undertaker: MB Kilmer