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Davis, Patricia Ann - l 2 2 Z, NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex E Patricia Ann Davis Female s Date of Death Age If Veteran of U.S.Armed Forces, 11/17/2020 79 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital ILIIIIa Manner of Death © Natural Cause 1=1 Accident E Homicide El Suicide El Undetermined El Pending Circumstances Investigation W Medical Certifier Name Title 0 Scott Biasetti MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 518 Burial Date Cemetery,Crematory or Facility Name 11/19/2020 Pine View Crematory '?e LI Entombment Address X❑Cremation Queensbury Town,New York Donation Z Removal Date Place Removed Fr and/or and/or Held Hold Address d Date Point of CO ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Li Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom 11.4 Remains are Shipped,If Other than Above a Address i a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/18/2020 Registrar of Vital Statistics Np6ertAndrew Curtis(ECectronicalty 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: Z ^J Date of Disposition �/ 9-2t+'L�p Place of Disposition �YIiLv i Lr,,rJ Lr'e-n?�.�-o r11 W (addrets) W N (section) r (lot number) (grave number) 0 Name of Sexton or Pers n C arge of Premises `� 1,...114..n 6.,a rn G,rti4 4 z (please print) W Signature Title C!ems eviCy *) / DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) '`' 0 1..` 214 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# ;" ;