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Calhoun, Patricia NEW YORK STATE DEPARTMENT OF HEALTH ?ij Vital Records Section Burial - Transit Permit Name First Middle Last Sex kc Patricia L. Calhoun Female Date of Death Age If Veteran of U.S. Armed Forces, December 15,2014 62 War or Dates b Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital ei Manner of Death NNatural Cause I 'Accident ri Homicide Suicide Undetermined n Pending t Circumstances Investigation I Medical Certifier Name Title Sean Bain MD '::.v.; Address ` ] 100 Park St.,Glens Falls,NY 12801 s.�.1 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls,NY 5601 S 7 9 ❑Burial Date Cemetery or Crematory December 22,2014 Pine View Crematory 0 Entombment Address ©Cremation 21 Quaker Rd., Queensbury,NY 12804 Date Place Removed Z I I Removal and/or Held and/or Address H Hold V) 0 Date Point of c Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address n Reinterment Date Cemetery Address P Permit Issued to Registration Number a.' Name of Funeral Home Alexander-Baker Funeral Home 00037 Address ` x- 3809 Main Street,Warrensburg,NY 12885 °E::; Name of Funeral Firm MakingDisposition or to Whom 441� . P Remains are Shipped, If Other than Above Address IX 4 .::A Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12-17-14 Registrar of Vital Statistics t CA`.wYy-Q' (signatu e) fi°5v t�� District NumberPlace �= S'�p 0 � Glens Falls,NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: tuDate of Disposition 12 f 23i/i Place of Disposition f::,, v,,,,,r (-moo*%,.. 2; (address) Cl) CL (section) 4 -(lot number)`, (grave number) QName of Sexton or Person in Charge of Premises f• %lievia Z 1 please print) W / Signature Title CIVOliTiV— (over) DOH-1555(02/2004)