Rabe, Patricia 5,0 3
NEW YORK STATE DEPARTMENT OF HEALTH t )
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Patricia May Rabe Female
Date of Death Age If Veteran of U.S. Armed Forces,
Sept. 02, 2014 70 yrs. War or Dates no
}• Place of Death Hospital, Institutio or
CityLU Town or Village Glens Falls Street Address Glens Falls Hospita
, l
Manner of Death Lurm Natural Cause 0 Accident 0 Homicide 0 Suicide riUndetermined El Pending
Circumstances Investigation
til Medical Certifier Name Title
Darci Gaiotti-Grubbs MD.
Address
102 Park St. , Glens Falls, NY. 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 4 1
❑Burial Date • Cemetery or Crematory
❑Entombment Sept. 03, 2014 PineView Crematorium
Address
;;;;Cremation Queensbury, NY. 12804
Date Place Removed
E❑Removal and/or Held
and/or Address
tilt=" Hold
Date Point of
Transportation Shipment
G by Common Destination
Carrier
El Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Mason Funeral Home 01117
Address
18 George St. , PO. Box 277, Fort Ann, NY. 12827
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
CC
IU
P" Permission is hereby granted to dispose of the human remains described above as indic ted.
e
«> Date Issued 0 9/0 2/2 01 4 Registrar of Vital Statistics GL.L, .0 J ).
(signature
District Number 5601 Place City of Glens Falls, .
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k
LU Date of Disposition gig I!'� Place of Disposition ►���.. C..-4001.-
(address)
Ui
(section) j'tloo numb (grave number)
Name of Sexton or Person in Charge of Premises �r•t . - $r t
z /�% (p/ ase print)
Signature `if Title C"l►ffOL
(over)
DOH-1555 (02/2004)