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Harvey, Patricia V. bq1 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patricia V.Harvey Female Date of Death Age If Veteran of U.S.Armed Forces, 08/21/2021 79 Years War or Dates H, Place of Death Hospital,Institution or WCity,Town or Village Johnsburg Town Street Address Elderwood at North Creek Ca Manner of Death ©Natural Cause ❑Accident 0 Homicide ❑Suicide 0 Undetermined 0 Pending W Circumstances Investigation W Medical Certifier Name Title G John Quaresima MD Address 112 Ski Bowl Road,Johnsburg Town,New York 12853 Death Certificate Filed District Number Register Number City,Town or Village North Creek 5655 30 0 Burial Date Cemetery,Crematory or Facility Name 08/24/2021 Pine View Crematory ❑Entombment Address ElCremation Queensbury Town,New York 0 Donation Z Removal Date Place Removed and/or and/or Held H N Hold Address 0 Date Point of V) L j Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address E Reinterment Date Cemetery Address 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 N Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/23/2021 Registrar of Vital Statistics KcithCeen C.Lorah(ECectronicalry Signed) (signature) i District Number 5655 Place North Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition i-.14-;.e2 1 Place of Disposition p,„, ��b,) �'?'$l ' (address) W N (section) (lot number) (grave number) CC 0 Name of Sexton or Person in Charge of Premises '~'�'Y S� ''�3 (please print) W Signature -G�� ) Title C ,iCll ici lor DOH-1555(07/18)p 1 of 2 f� .. 5 0 ' Public Health Law Sec. 4145(2b) Receipt i Human remains of ' delivered on 1 , 20 P' / ! / , , � `,`'':r�// ', __� .... Pine View CemeteryRepresentingfuneralnamed on burial permit Official Funeral Directors Reg.or License# ° -' ` /