Slavin, Patricia NEW YORK STATE DEPARTMENT OF HEALTH ` 1 p
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Patricia Jane Slavin Female
Date of Death Age If Veteran of U.S. Armed Forces,
October 12, 2013 88 War or Dates
Place of Death Hospital, Institution or
Z,. City, Town or Village Glens Falls Street Address The Pines
0 Manner of Death j Natural Cause ❑ Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
0 Patricia Auer,
Address
Queenbury Hudson Headwaters, 12894
Death Certificate Filed District Numb 1 Register Mer
City, Town or Village C
O Burial Date Cemetery or Crematory
October 16, 2013 Pine View Crematorium
❑Entombment Address
: ®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
• Removal and/or Held
Hold r Address
O Date Point of
0
a ❑Transportation Shipment
0 by Common Destination
Ct Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
s Name of Funeral Firm Making Disposition or to Whom
1,.; Remains are Shipped, If Other than Above
2 Address
it
it
11, Permission is hereby ranted to dispose of the human remains des d bov sin
Date Issued l0 /S 27/3 Registrar of Vital Statistics
(signature)
District Numb r 47 Place -- s 4' 1/l /9 k'//
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w' Date of Disposition fli(/l jt3 Place of Disposition ti'Itid".) f pt—
W (address)
fl?.
at (section) Inumber)
r- (grave number)
0
a Name of Sexton or Person i Charge of P raises vs ...�L.^�11"
z (please rint)
W;, Signature Title alEinliat
(over)
DOH-1555 (02/2004)