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Bujold, Patricia NEW YORK STATE DEPARTMENT OF HEALTH # NI Vital Records Section Burial - Transit Permit Name First Middle Last Sex Patricia Bujold Female �"j Date of Death Age If Veteran of U.S. Armed Forces, ry March 3,2014 79 War or Dates -• Place of Death Hospital, Institution or , City, Town or Village Fort Edward Street Address 32 Gates Avenue 5 Manner of Death X Natural Cause I 'Accident Homicide [Suicide [ Undetermined Pending Circumstances - Investigation u; Medical Certifier Name Title Darci Ann Gaiotti-Grubbs y= Address 102 Park St. _ :: Death Certificate Filed District Number Register umber :,:, City, Town or Village Fort Edward 5755 iq ❑Burial Date Cemetery or Crematory March 5,2014 Pine View Crematory DI Entombment Address ©-Cremation 21 Quaker Rd., Queensbury,NY 12804 Date Place Removed ZO I I Removal and/or Held and/or Address F Hold C O Date Point of N n Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address x7:, Permit Issued to Registration Number :rs Name of Funeral Home Alexander-Baker Funeral Home 00037 nF; pi; Address 3809 Main Street,Warrensburg,NY 12885 '.%-- Name of Funeral Firm Making Disposition or to Whom "s` Remains are Shipped, If Other than Above Address _• ; Permission is he eby ranted to dispose of the human re 'ns described above as indicated. g l,/0 0 h =E Date Issued Registrar of Vital Statistics , "„ signature) V 4 µ 2 District Number 5755 Place Fort Edward I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z f� -) w Date of Disposition 3/Z;I i , ik Place of Disposition a C It-ciOr:4_ (address) W W (section) / (lot neimber) (grave number) pName of Sexton or Person in Charge of Premises 6 6-1- i' -ii Z (please print) W Signature Title Gia ipl-6it (over) DOH-1555 (02/2004)