Yosco, Patricia NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section r Burial - Transi rmit
Name First Middle Last Sex
Patricia Catherine Yosco Female
Date of Death Age If Veteran of U.S. Armed Forces,
06/06/2013 67 War or Dates
I— Place of Death Hospital, Institution or
W
Z City, Town or Village GLENS FALLS Street Address GLENS FALLS HOSPITAL
WManner of DeathELI Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
V Circumstances Investigation
WCI Medical Certifier �� > � Title
Address la '/< (7 d (�L /ix--- /t 7/)`7aJ
h Certificate Filed /� District Number � Register Number
Ci , Town or Village ea,,,,,,,i,-47p 2- `-.1
❑Burial Date Cemetery.or Crematory
El Entombment 06/07/2013 U� l�(�� �/2�laZ„�,/, y�i-i'
Address
®Cremation C L ? '.G f vC ✓Z /,Po,/
Removal Date Place Removed
❑ and/or Held
o and/or Address
F- Hold
(7 Date Point of
d ❑Transportation Shipment
U) by Common Destination
D Carrier
Date Cemetery Address
CA Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
Address
9 Pine St/P.O. Box 455 Chestertown NY 12817
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
2 Address
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0' Permission is herebygranted to dispose
of the human remains described above as indicated.
Date Issued 6) -7 113 Registrar of Vital Statistics ck_k✓1'V- LA)
(signature)'�l�' L
District Number cG O ( Place () / .i\S Ivo\\\ , p >.
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I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition .a r 1063 Place of Disposition PetUko./ frig-c jr Wk.
W (address)
CO
Cc (section) (lot num r) (grave number)
o• Name of Sexton or Person in C rge of Premiss y £ wr
Z (please print)
W Signature Title Cr ►1-rOt -
. (over)
DOH-1555(02/2004)