Patterson, Aileen NEW YORK STATE DEPARTMENT OF HEALTH ' / # 25
Vital Records Section Burial - Transit Permit
t Name First Middle Last Sex
Alieen Marie Patterson Female
• Date of Death Age If Veteran of U.S. Armed Forces,
May 4, 2014 89 War or Dates
! Place of Death Hospital, Institution or
gt City, Town or Village Moreau Street Address Home of The Good Shepherd
Manner of Death mr1
L.i Natural Cause ❑ Accident ❑Homicide ❑ Suicide ❑ Undetermined ❑ Pending
4' Circumstances Investigation
1 .; 9
Medical Certifier Name Title
Paul R. Filion, Dr.
Address
2 Irongate Center Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
r - City, Town or Village Moreau i-156Z_
;❑Burial Date Cemetery or Crematory
g44May 5, 2014 Pine View Crematory
❑Entombment Address
;;.®Cremation Quaker Road Queensbury,NY 12804
444,5 Date Place Removed
a,; ❑ Removal and/or Held
r and/or Address
Hold
-• ; Date Point of
❑Transportation Shipment
by Common Destination
Carrier
❑
Date Cemetery Address
Disinterment
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
,; Name of Funeral Home M.B. Kilmer Funeral Home 01078
414,
': Address
136 Main Street, South Glens Falls NY 12803
t Name of Funeral Firm Making Disposition or to Whom
`¢ < Remains are Shipped, If Other than Above
Address
•
Permission is hereby granted to dispose of the human rema' s described above as indicated.
Date Issued,�`�-/4
Registrar of Vital Statistics , � �
(signature)
District Number C�6,,2 , Place � //I .a_
• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 05/05/2014 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) is/ (lot nu er) (grave number)
remises
Name of Sexton or Perso in Charge o P e ses `ir,s
(please print)
Signature ,L Title Melit '
(over)
DOH-1555 (02/2004)