Flynn, Patricia Elizabeth # 131�
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Patricia Elizabeth Flynn Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/15/2020 91 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Bolton Town Street Address 4605 Lake Shore Drive,Bolton Town, New York 12814
pManner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined ❑Pending
✓ Circumstances Investigation
0 Medical Certifier Name Title
Mary Stein NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Bolton Landing 5650 12
ElBurial Date Cemetery,Crematory or Facility Name
12/16/2020 Pine View Crematory
Entombment Address
ElCremation Queensbury Town,New York
11 Donation
Removal Date Place Removed
and/or and/or Held
~N Hold Address
0
D. Date Point of
(I) ❑Transportation
p by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped,If Other than Above
• Address
Q
W
d Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/16/2020 Registrar of Vital Statistics Jodi'L Cannalf'(EYectronicalySWra
(signature)
District Number 5650 Place Bolton Landing, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IF-
's. Date of Disposition f -/7-402,0 Place of Disposition 1. C
2 (address)
W
CC N
A (section) (lot number) (grave number)
0 Name of Sexton or Person in Charee of Pre is / jw-u 4,✓ e• es6ci
Z / (please prin
W Signatures. Title Qc
DOH-1555(07/18)p i of 2
. . f 4 3 1
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
1
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#