Zwick, Patricia - , # le?s
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Patricia Clair Zwick Female
rr?�. Date of Death Age If Veteran of U.S. Armed Forces,
::E. ; February 22, 2014 78 War or Dates n/a
Place of Death Hospital, Institution or
City, Town or Village Johnsburg Street Address Adirondack Tri County Nursing Home
Manner of Death I XI Natural Cause Accident ( (Homicide Suicide Undetermined Pending
Titi
Circumstances Investigation
`' Medical Certifier Nam��S �\\���lr
Address
iss Death Certificate Filed District Num'tler Register umber
: City, Town or Village Johnsburg,NY
❑Burial Date Cemetery or Crematory
February 25, 2014 Pine View Crematory
❑Entombment Address
0 Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z ^Removal and/or Held
C; and/or Address
H Hold
t
O Date Point of
0 Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
(Reinterment Date Cemetery Address
Permit Issued to Registration Number
••:;:m Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 12804
ip Name of Funeral Firm Making Disposition or to Whom
1,1 Remains are Shipped, If Other than Above
Address
:. Permission is hereby granted to dispose of the human r 'ns described above as indicated.
Date Issued a- ay-- aoq Registrar of Vital Statistic "i 29 CJ_,
(signature
District Number 4c),F:, Place Johnsburg,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
wDate of Disposition a ia1.liV Place of Disposition cL., �z,,t10r,,;.�..
2 (address)
W
U)
0 (section) j (lot number) (grave number)
pName of Sexton or Person 'n Charge of Premises r,t} 1.,,
Z / (please print)
Signature I Title Ctrintrit,
(over)
DOH-1555(02/2004)