Baker, Patricia NEW YORKSTATE DEPARTMENT OF HEALTH > - Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Patricia Baker Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/08/2022 76 Years War or Dates
i— Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
0 Manner of Death El Natural Cause Accident El Homicide OSuicide Undetermined El Pending
V Circumstances Investigation
W Medical Certifier Name Title
G Matthew Loftus PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed CityOf Glens Falls District Number Register Number
,Town or Village Ce 5601 153
Burial Date Cemetery,Crematory or Facility Name View 03/10/2022
Pine Crematory
Entombment Address
Cremation Queensbury Town,New York
tElDonation
0❑Removal Date Place Removed
and/or and/or Held
NHold Address
0
O. Date Point of
U) Transportation
5 by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
2 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/10/2022 Registrar of Vital Statistics Afigiatt.Wan(fktrot Sigtud)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:W Date of Disposition 3I Ii I Z2 Place of Disposition 7a /
2 (address)
W
U)
CC (section) �/0(lotf►umber) 'I (grave number)
Q
S il,
Name of Sexton or Person in Charge of Pre s
Z (ple a print) r� �
W Signature Title r �/O
DOH 1555(07/18)p 1 of 2
01587 4
fie..
Public Health Law Sec. 4145(2b)
Receipt
Human remains of s delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#