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Engwer, Patricia Ellen c NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patricia Ellen Engwer Female Date of Death Age If Veteran of U.S.Armed Forces, 01/14/2021 86 Years War or Dates H Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital O Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide Ei Undetermined 1:1Pending W Circumstances Investigation W Medical Certifier Name Title O Shahid Ahmed MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 30 Burial Date Cemetery,Crematory or Facility Name 01/19/2021 Pine View Crematory ElEntombment Address lCremation Queensbury Town,New York ElDonation Z 0 Removal Date Place Removed and/or and/or Held H Hold Address N Q. 1-1 Date Point of Cl) ❑Transportation Shipment p by Common Carrier Destination Date Cemetery Address ❑Disinterment El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls, New York 12803 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above g Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/17/2021 Registrar of Vital Statistics Robert Andrew Curtis(Electronically 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: F— Z Date of Disposition l/I S I Zi Place of Disposition Z.IL pJ (address) W CO tr (section) (!otpumber) �j�, (grave number) gName of Sexton or Person in Charge of Pr ises - v 'tif�t 0 (please print) W Signature L Title g DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014424 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#