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Hall, Patricia May .it- g17 . . ,... ...,—.... NEW YORKSTATE DEPARTMENT OF HEALTH - Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patricia May Hall Female Date of Death Age If Veteran of U.S.Armed Forces, 10/24/2021 75 Years War or Dates • F Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death © W Natural Cause ❑Accident 1=1 Homicide 1:1Suicide ElUndetermined EI Pending V Circumstances Investigation WW Medical Certifier Name Title CI Sean Bain MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 462 ❑Burial Date Cemetery,Crematory or Facility Name 10/27/2021 P'ne View Crematorium El Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held F- Hold Address N 0 U)CL ❑Transportation Date Point of p by Common Shipment Carrier Destination Disinterment Date Cemetery Address 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 F 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 10/27/2021 Registrar of Vital Statistics Wp6ertAndrew Curtis(E(ectronicaf(ySigned) (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: I - tq /� Z Date of Disposition /D, t Place of Disposition t�Lt Y� l fdf r._ 2 (address) W cc N (section) n (lot number) (grave number) 8 Name of Sexton or Person in Charge of remises 1 L -++ti fir z Z." /Plea e punt/W ieffiffrO Signature ti— Title ��2C DOH-1555(07/18)pi of 2 (,) Public Health Law Sec. 4145(2b) Receipt I Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on bur*l,permit Official Funeral Directors Reg.or License#