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Patton, Wilma (,, 0NEW YORK STATE DEPARTMENT OF HEALTH , . it Vital Records Section Burial - Transit P ermit Name First Middle Last Sex Wilma S. Patton Female Date of Death Age If Veteran of U.S. Armed Forces, November 13, 2013 90 War or Dates H Place of Death Hospital, Institution or Z City, Town or Village Saratoga Springs Street Address 127 Gilbert Road pManner of Death ❑X Natural Cause El Accident ❑Homicide ❑Suicide E Undetermined n Pending W Circumstances Investigation W Medical Certifier Name Title t3 Michael Adams MD Address 1448 Rte 9,South Glens Falls,NY 12803 Death Certificate Filed District Number Register—�Number City, Town or Village Saratoga Springs 4501 ❑Burial Date Cemetery or Crematory November 15,2013 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road, Queensbury,NY 12804 Date Place Removed Z ❑Removal and/or Held and/or Address - Hold U) o Date Point of es ElTransportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Road, Queensbury,NY 12804 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped, If Other than Above 2 Address IY W a. Permission is hereby granted to dispose of the human rem ' e =allyindicatDate Issued \ `4-I2t3 Registrar of Vital Statistics (signature) District Number 4501 Place Saratoga Springs I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition//-/9-/i Place of Disposition �✓ L. C .,1, ,4j' 2 (address) W co rt (section) jg:::;7ber)cir. (grave number) QName of Sexton or /nZigierarge of Premises �Co l� t Z (please print W Signature Title t� y3r j' (over) DOH-1555(02/2004)