Yole-Meade, Patricia Taylor f
NEW YORK STATE DEPARTMENT OF HEALTH LF
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Patricia Taylor Yole Female
Date of Death Age If Veteran of U.S. Armed Forces,
January 16, 2021 91 War or Dates
Place of Death Hospital, Institution or
W City, Town or Village Queensbury Street Address Glens Falls Center
CI 1,11
Manner of Death Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
0 Circumstances Investigation
W Medical Certifier Name Title
Jennifer Donavan,
Address
100 Park Street Glens Falls, NY 12801
Death Certificate Filed District Number �� -1 Register Number
t City, Town or Village Queensbury 5 7-
®Burial Date Cemetery or Crematory
May 14, 2021 Friends Cemetery
❑Entombment Address
0 Cremation Cronin and Ridge Roads Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
• and/or Address
F Hold
t Date Point of
eL ❑Transportation Shipment
0 by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078
Address
136 Main Street, South Glens Falls NY 12803
Name of Funeral Firm Making Disposition or to Whom
L Remains are Shipped, If Other than Above
2 Address
- Permission is hereby granted to dispose of the human s descri ed ov as indicated.
Date Issued 'i/7/202-I Registrar of Vital Statistics '
(signature)
District Number �75� Place �61,()'n r Ed- ua/1d
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition 05/14/2021 Place of Disposition Cronin and Ridge Roads Queensbury,NY 12804
2 (address)
111
CO Friends Cemetery
C (section) (lot numtfer) (grave number)
G Name of Sex on or Person in Charge of Premises c'nnn i P Goedert
Z / (please print)
W Signatur i . 12 1 Title Superintendent
(over)
DOH-1555 (02/2004)
Public Health Law Sec. 4145(2b)
u1.285 5
Receipt
Human remains of delivered on ---',', 20 2/
Pine View Cemetery Representing-the funeral home named on burial permit
Official Funeral Directors Reg.or License#
MEADS/Yole ( F)
NAME Patricia Taylor Meade Yoli'ge: 91 —
Lot Owner: Meade Family Plot
Lot# Family Plot Grave#
Case: Concrete
Died: 1 /1 6/2 0 21 Interred:5/1 4/2 0 21
Funeral Home: M.B. Kilmer
Cemetery: Friends Cemetery