Knapp, Patricia 0 z $ 1
NEWYORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Patricia Mae Knapp Female
Date of Death Age If Veteran of U.S. Armed Forces,
10/19/2018 70 Years War or Dates
Place of Death Hospital, Institution or
- City, Town or Village Glens Falls Street Address Glens Falls Hospital
• Manner of Death am
IEJ Natural Cause Accident El Homicide El Suicide El Undetermined n Pending
Circumstances Investigation
vt Medical Certifier Name Title
Jean Vanauken PA
Address
100 Park St,Glens Falls,New York 12801
-` Death Certificate Filed District Number Register Number
4 City, Town or Village Glens Falls 5601 495
El Burial Date Cemetery or Crematory
10/23/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or
Address
Hold
Date I Point of
❑Transportation LSD_Eipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
• Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
-44
4 Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
Address
r
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/23/2018 Registrar of Vital Statistics Ro6ertA Curtis fEfectronicalf Signed)
(signature)
District Number 5601 Place Glens Falls, New York
• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition Place of Disposition
(address)
„
(section) (lot number) (grave number)
• Name of Sexton or Person in Charge of Premises
(please print)
Signature Title
(over)
DOH-1555 (02/2004)