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Reilly, Patricia t li i Z3 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Patricia Rein Female Date of Death Age If Veteran of U.S. Armed Forces, Ma 4 2012 72 War or Dates gPlace of Death Hospital, Institution or nf� City, Town or Village Glens Falls Street Address Glens Falls Hospital izManner of Death I I Natural Cause 'Accident I 'Homicide Suicide Undetermined -Pending Circumstances Investigation g Medical Certifier Name Title Q Address Death Certificate Filed District Numbe5601 Register Num er City, Town or Village Glens Falls �J ❑Burial Date Cemetery or Crematory Address ❑Entombment May 7, 2012 Pine View Crematorium ©Cremation 21 Quaker Road, Queensbury,NY 12804 Date Place Removed Z Removal and/or Held O and/or Address I" Hold N o Date Point of N I 'Transportation Shipment p by Common Destination Carrier Disinterment Date i Cemetery Address Reinterment Date Cemetery Address • Permit Issued to Registration Number Name of Funeral Home Regan & Denny Stafford Funeral Home 01443 Address ▪ 53 Quaker Road,Queensbury, NY 12804 Name of Funeral Firm Making Disposition or to Whom 1 +: Remains are Shipped, If Other than Above R, Address re tit ., Permission is hereby granted to dispose of the huma remains d scribed a e as Indic ted. • Date Issued Registrar of Vital Statistics a-P�,p� - (signature) District Number 5601 Place Glens Falls I certify that the remains of the decedent identified above wer disposed of in accordance with this permit on: Z W Date of Dispositions- --gyp t7. Place of Disposition P'neoc',c C e wr`-L- ),.,,W1 W (address) V) re (section) (lot number) (grave number) z Name of Sexton or Person in Charge of Premises ,,,,� ,,.,,.4 L7.. - . U( ui --- (please print) Signature px„Lff. Title Cr,c,K4,fe,r�, . l (over) DOH-1555(02/2004)