Hayes, Patrick NEW YORK STATE DEPARTMENT OF HEALTH
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Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Patrick Terrance Hayes Male
Date of Death Age If Veteran of U.S. Armed Forces,
02/07/2015 67 years War or Dates
: Place of Death Hospital, Institution or
W town orHX Colonie Street Address 20 Airport Park Blvd
0 Manner of Death❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
ti4 Circumstances Investigation
W Medical Certifier Name Title
Q Paul A Marra Coroner
Address
112 State Street, Albany, New York 12207
Death Certificate Filed District Number Register Number
R0040Town or Y Colonie 153 35
['Burial Date Cemetery or Crematory
❑Entombment 02/18/2015 Pine View Creamatory
Address
Cremation Queensbury, New York 12804
Date Place Removed
Z n Removal and/or Held
9 and/or Address
H Hold
41)
0 Date Point of
Transportation Shipment
G1 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 01078
Address
136 Main Street So. Glens Falls, New York 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
It
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` Permission is hereby granted to dispose of the human r ins describe bove as indicated.
iiia Date Issued 02/11/2015 Registrar of Vital Statistics a_
(signature)
District Number 153 Place Colonie
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
It Date of Disposition ZJI$ilh' Place of Disposition F•i --t Cmer_
2 (address)
Lu
CO
CC (section) (lot number) (grave number)
el Name of Sexton or Person in Charge of Premises A^S .Smell
(please print)
laSignature Title C i`w`nt
(over)
DOH-1555 (02/2004)