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Nolan, Patrick Robert $ 731 41111;1.1111111P NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patrick Robert Nolan Male Date of Death Age If Veteran of U.S.Armed F 08/25/2021 49 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Hudson Falls Village Street Address 2 Lincoln Street, Hudson Falls Village, New York 12839 p Manner of Death ©Natural Cause El Accident ❑Homicide ❑Suicide 0 Undetermined ❑Pending W Circumstances Investigation U . W Medical Certifier Name Title CI Robert Lemieux Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed District Number Register Number City,Town or Village Hudson Falls Village 5726 23 0 Burial Date Cemetery, or Facility Name 08/30/2021 Pine View Crema onum ❑Entombment Address 0 Cremation Queensbury Town,New York Donation Date Place Removed ZO Removal and/or Held - and/or (/) Hold Address 0 n. Date Point of (/) ❑Transportation Shipment Q by Common Carrier Destination Date Cemetery Address 0 Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67, Hudson Falls, New York 12839 Name of Funeral Firm Making Disposition or to Whom i- Remains are Shipped,If Other than Above 2 Address CC W CI- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/26/2021 Registrar of Vital Statistics CynthiaA Cardin(ECectronica1CySigned) (signature) District Number 5726 Place Hudson Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— q � Iel"---- Z Date of Disposition I �l i l.' Place of Disposition `Y ut� W (address) W C (section) (lot number) (grave number) 0 i- Name of Sexton or Person in Charge of P miles al ZXi; (pie a print) W Signature =S'�---' Title ieV44W Irrt DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1 lb— . 0*,,I: Ei 097 Receipt .,./) r)I j ',7 , ._...._ t00 Human remains of , .4 re, d on , 20 , .. .. . Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#