Patterson, Marilyn F. , _ -4 3`1ii
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Marilyn F.Patterson Female
Date of Death Age If Veteran of U.S.Armed Forces, ^^
04/07/2021 84 Years War or Dates
F— Place of Death Hospital,Institution or
Z City,Town or Village Valatie Village Street Address Barnwell Nursing And Rehabilitation Center
XIWW Manner of Death
Natural Cause ❑Accident ElHomicide ❑Suicide ❑Undetermined ❑Pending
C.) Circumstances Investigation
0LLI Medical Certifier Name Title
Kathleen Steiger NP
Address
3230 Church St,Valatie Village,New York 12184
Death Certificate Filed District Number Register Number
City,Town or Village Valatie Village 1023 17
❑Burial Date Cemetery,Crematory or Facility Name
04/10/2021 Pine View Crematory
❑Entombment Address
ElCremation Queensbury Town,New York
❑Donation
0 ❑Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
0
O. Date Point of
(I) ❑Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
❑Disinterment
Date Cemetery Address
El Reinterment
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
1.— Remains are Shipped,If Other than Above
2 Address
Q
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/09/2021 Registrar of Vital Statistics Barbara Ann Tischer(ECectronicaltySigned)
(signature)
District Number 1023 Place Valatie Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IH
Z Date of Disposition y J 13171 Place of Disposition 47yulL cry
W
2 (address)
W
N (section) (! umber) (grave number)
CC
0 Name of Sexton or Person in Charge of Premises, V., ��""` 44�Zplease pn /
W Signature e c.,aTitle G �'��1t�
DOH-1555(07/18)p 1 of 2
1 Public Health Law Sec. 4145(2b) "f `n
1
Receipt
1 Human remains of a` ' delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# r
1