Delaire, Patricia NEW YORK STATE DEPARTMENT OF HEALTH l6U1O
Vital Records Section Burial - Transit Permit
Name First Middle Last Last Sex
PATRICIA LYNN DELAIRE FEMALE
Date of Death Age If Veteran of U.S.Armed Forces,
08/17/2015 52 War or Dates NO
Place of Death Hospital, Institution
Z City,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
GManner of Death Natural ❑ Undetermined ❑ Pending
ElW ® Cause Accident ❑ Homicide ❑ Suicide Circumstances Investigation
W' Medical Certifier Name Title
Q KAREEM KASSEL MD
Address
43 NEW SCOTTLAND AVE ALBANY NY 12208
Death Certificate Filed District Number Register Number
. City,Town or Village City of Albany 101 1751
' Date Cemetery or Crematory
❑ Burial 08/18/2015 PINE VIEW CREMATORY
❑ Entombment Address
Z Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
9— ❑ and/or Address
I-- Hold
N
Date Point of
CL Transportation Shipment
CO; ❑ By Common Destination
Carrier
❑ Date Cemetery Address
Disinterment
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home BAKER FUNERAL HOME 00130
Address
11 LAFAYETTE ST. QUEENSBURY, NY 12804
µ Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped, If Other than Above
X Address
IL' Permission is hereby granted to dispose of the human remains d=.- . • above as indicated.
Date 08/17/2015 Registrar of Vital Statistics - V\ L.. -,a Q �.
Issued -.'.i ature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition Si LDi/r Place of Disposition �h+daV+h✓ Grc-rfQ/ty'
W (address)
W:
co
0 (section) 1 (lot number) (grave number)
G <
�Z, Name of Sexton or Person in Charge of Premises ffipl^ .S�t4
di
(please print) �, j�
Signature Title eri �`" �• "
(over)
DOH-1555 (02/2004)