Hassett, Patricia Caroline LOF 7/0r
NEW YORK STATE DEPARTMENT OF HEALTH Burial- Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Patricia Caroline Hassell Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/08/2022 90 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death ID Natural Ca use Accident 0 Homicide Suicide FlUndetermined ❑Pending
IliC.) Circumstances Investigation
W Medical Certifier Name Title
O Howard Silverberg MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
Ci E,Town or Ville 5601 203
Burial Date Cemetery,Crematory or Facility Name
Addre2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
DDonation
Demo Date Place Removed
and/or and/or Held
H Hold Address
N
0
Date Point of
N❑Transportation Shipment
Q by Common
Carrier Destination
['DisintermentDate Cemetery Address
Date Cemetery Address
El Reinterment
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
SAddress
CC
W
G. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/08/2022 Registrar of Vital Statistics .W'gan,12 n(Eketrortic4.yStts4
/signature/
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed cf in accordance with this permit on:
H �(
2 Date of Disposition 1 Ili(2L Place of Disposition — Ar
2 (address)
W
N (section/ (lot number) (grave number/
IX �A
8 Name of Sexton or Person in Charge of Premises R` ✓1'r14 i ft
z JG /% /p se print/ °1"�
W Signature /, Y Title
DOH 1555(07/18)p 1of 2
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#