Tedesco, Patricia NEW YORK STATE DEPARTMENT OF HEALTH ` i1 3ZS`
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
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Patricia O'Neil Tedesco Female
Date of Death Age If Veteran of U.S. Armed Forces,
f May 14,2014 75 War or Dates
''' Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address 50 William Street
Manner of Death IN Natural Cause ❑Accident ❑Homicide Suicide n Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Dr Petracca,MD
f Address
Glens Falls,NY 12801
%' Death Certificate Filed District Number Register Number
• City, Town or Village 9 Glens Falls,NY 5601 2 2_9
❑Burial Date Cemetery or Crematory
May 21,2014 Pine View Crematorium
❑Entombment Address
❑x Cremation 21 Quaker Road, Queensbury,NY 12804
Date Place Removed
ZZ n Removal and/or Held
and/or Address
H Hold
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O Date Point of
Nn Transportation Shipment
a by Common Destination
Carrier
pi Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road, Queensbury, NY 12804
r
r � Name of Funeral Firm Making Disposition or to Whom
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„4 Remains are Shipped, If Other than Above
--- Address
Permission is hereby granted to dispose of the human remains described above as indicated.
;f Date Issued 5 i + 6 0 9 Registrar of Vital Statistics Lj Q W�tiIN-
(signature)
F District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition Sip'J14/ Place of Disposition Zi 4.+ (,rYrv4cc i1
(address)
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CO
fY
(section) (lot number) ((''''- (grave number)
pName of Sexton or Perso in Charge Premises ti Jt114-
Z ( ease print)
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Signature Title ME'I1'} k
(over)
DOH-1555(02/2004)