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Coon-Center, Patricia NEW YORK STATE DEPARTMENT OF HEALTH 4., Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patricia Coon-Center Female Date of Death Age If Veteran of U.S.Armed Forces 11/13/2021 80 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital ILI p Manner of Death ©Natural Cause Accident ❑Homicide El Suicide ❑Undetermined El Pending W Circumstances Investigation W Medical Certifier Name Title G Mathew Varughese DO Address ' 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 516 ElBurial Date Cemetery,Crematory or Facility Name 11/16/2021 Pine View Crematorium Entombment Address 12 Cremation Queensbury Town,New York Donation Removal Date Place Removed and/or and/or Held H Hold Address N 0 O. Date Point of N ❑Transportation Shipment p by Common Carrier Destination Date Cemetery Address Disinterment ElReinterment 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 H Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/16/2021 Registrar of Vital Statistics 1Z96ertAndrew Curtis(ECectronically 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: Z Date of Disposition I I//1 Ili Place of Disposition .(L L W (address) W Lb CC (section) //ot tuber/ (grave number) ! gName of Sexton or Person in Charge of Premise 1.4 t`f z (please prm W Signature Title ` '� i --• DOH-1555(07/18)p 1 of 2 I _ y ;. .. F ?40 Public Health Law Sec. 4145(2b) IReceipt 1 1 Human remains of delivered on , 20 1 I 1 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#