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Fishlock, Patricia Lillian . _. , id Ln 1 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patricia Lillian Fishlock Female Date of Death Age If Veteran of U.S.Armed Forces, 11/14/2021 72 Years War or Dates 1967-1969 H Place of Death Hospital,Institution or Z City,Town or Village South Glens Falls Village Street Address 25 William Street,South Glens Falls Village,New York 12803 W Manner of Death © Natural Cause 1=1 Accident I=1 Homicide Suicide E Undetermined 0 Pending V Circumstances Investigation LU Medical Certifier Name Title a Mark Quaresima MD Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed District Number Register Number City,Town or Village South Glens Falls Village 4524 Burial Date Cemetery,Crematory or Facility Name 11/16/2021 Pine View Crematory ❑Entombment Address ICremation Queensbury Town,New York ❑Donation g ❑Removal Date Place Removed and/or and/or Held H Hold Address CO () O. Date Point of (!) Li Transportation CI Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom ., Remains are Shipped,If Other than Above 2 Address CC W Cl" Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/16/2021 Registrar of Vital Statistics Joy Bart(zoComew(E(ectronica1CySigned) (signature) District Number 4524 Place South Glens Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F— Z Date of Disposition II Jllp it Place of Disposition Z C9_ A.A-O� ILI (ad Tess) U.I CO tr (section) A (lot number) (grave number) QName of Sexton or Person in Charge of Pre El�Ip L- r Z (plse print) W Signature _ Title (ten^ DOH-1555(07/18)p 1 of 2 015338 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#