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Aurelia, Patrick ad NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Patrick Louis Aurelia Male Date of Death Age If Veteran of U.S. Armed Forces, December 5, 2015 49 War or Dates Place of Death Hospital, Institution or City, Town or Village Street Address 3159 State Route 4, Apt 19 W Manner of Death mNatural Cause Accident D Homicide El Suicide riUndetermined Pending Circumstances Investigation W Medical Certifier Name Title Michael Sikirica MD, Address 50 Broad Street Waterford, NY 12188 Death Certificate Filed District Number Register Number City, Town or Village w, / 7 ❑Burial Date Cemetery or Crematory December 8, 2015 Pine View Crematorium El Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held O and/or Address Hold St. Joseph's Cemetery 1 Date Point of a. ❑Transportation Shipment CO by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 I— Remains are Shipped, If Other than Above • Address W" a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued /c Registrar of Vital Statistics C rNwi.A_ -yc (signature) District Number c 6,j_ Place 7-a(4ih 6 7 n j S I vi) I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 12/08/2015 Place of Disposition Quaker Road Queensbury,NY 12804 (address) W CO ce (section) , (lot number) (grave number) pName of Sexton or Person in Charge of Premises U4n.} St4bvdf lease print) W Signature Title tiffatimC: (over) DOH-1555 (02/2004)