Clark, Patricia A ! f
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Patricia A.Clark Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/02/2021 74 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Greenwich Town Street Address 3344 State Route 29,Greenwich Town,New York 12834
p• Manner of Death X❑Natural Cause ❑Accident El HomicideEl Suicide ❑Undetermined Pending
U Circumstances Investigation
Q Medical Certifier Name Title
Matthew Pender MD
Address
35 Gilbert Street,Cambridge Village,New York 12816
Death Certificate Filed District Number Register Number
City,Town or Village Greenwich 5757 1
▪Burial Date Cemetery,Crematory or Facility Name
01/05/2021 Pine View Crematory
Entombment Address
X❑Cremation Queensbury Town,New York
❑Donation
O Removal Date Place Removed
and/or and/or Held
~ Hold Address
W
0
d Date Point of
Cl) ❑Transportation
by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
� . Remains are Shipped,If Other than Above
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/05/2021 Registrar of Vital Statistics Witelan(Electronica1T Slgned)
(signature)
District Number 5757 Place Greenwich, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition )/7 2( Place of Disposition R�,L„
2 (address)
W
♦C (section) 11#number) c (grave number)
O Name of Sexton or Person in Charge of Premises C /,r� f(�� �J imort
(please pA/nt/ /�,
W Signature �✓ f 6 Title °��" /TU—
DOH-1555(07/18)p t of 2
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Public Health Law Sec. 4145(2b) 314383
Receipt
Human remains of delivered on 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#