Forgette, Patricia NEW YORK STATE DEPARTMENT OF HEALTH Burial Records Section Burial - Transit Permit
35 Name First Middle Last • Sex
PATRICIA ANN FORGETTE FEMALE
Date of Death Age If Veteran of U.S. Armed Forces,
DEC 28, 2014 71 War or Dates N/A
Place of Death Hospital, Institution or
j. City, Town or Village CITY OF PLATTSBURGH Street Address CVPH MEDICAL CENTER
Manner of Death jj Natural Cause 0 Accident ❑Homicide D Suicide Undetermined ri Pending
Circumstances Investigation
ut Medical Certifier Name Title
. ' ROBERT BENAK MD
Address
PLATTSBURGH, NY
Death Certificate Filed District Number Register Number
gill City, Town or Village CITY OF PLATTSBURGH 901 ‘..1-762
`'' JBurial Date Cemetery or Crematory
DEC 30, 2014 PINE VIEW CREMATORY
El Entombment
Address
3®Cremation QUEENSBURY, NY •
::: Date Place Removed
❑Removal and/or Held
3 and/or Address
Hold
ia Date Point of
pi0 Transportation Shipment
8. by Common Destination
Carrier
'` Disinterment Date Cemetery Address
<< 0 Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home WILCOX & REGAN - 01821
Address
11 ALGONKIN STREET, TICONDEROGA, NY 12883
=' 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 remains desc 'bed ove as indica d.
Date Issued DEG,f , 2014 Registrar of Vital Statistics ift7 t /
ure)
District Number 901 Place CITY OF PLATTSBURGH
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
/� �/ C dJ^�
Date of Disposition I / 2/(5' Place of Disposition `IrntV....s
a (address)
g. (section) (ibt number) (grave number)
dt,044--
ti Name of Sexton or Person i Charge of Premises r" 'L -S
(please print)
Arl—
Signature Title (1M
(over)
DOH-1555 (02/2004) •