Wolff, Patricia J IS) # 3-)0
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Patricia J Wolf Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/02/2022 81 Years War or Dates
F,. Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
SManner of Death Ej Natural Cause DAcddent 0 Homicide ❑Suicide MUndetermined ❑Pending
InCircumstances Investigation
W Medical Certifier Name Title
0 Marvin Davidowitz MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
Cit ,Town or Village
g 5601 243
Burial Date Cemetery,Crematory or Facility Name
Addr/2022 Pine View Crematory
Entombment Address
ECremation Queensbury Town,New York
DDonation
C❑Removal Date Place Removed
and/or and/or Held
NHold Address
2 Date Point of
to❑Transportation Shipment
Q by Common
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
EIReinterment
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
2 Address
CC
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/03/2022 Registrar of Vital Statistics Sflsgan,M n(*E'Gctmnica4j'J nsa)
(signature)
District Number 5601 Place City Of Glens FaNs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition 5-j9 lit. Place of Disposition ......address)
W
Cr (motion) (lot number) (gram number)
8 Name of Sexton or Person in Charge of Premises 4 t.,toL._..lease t/ M��
z le
Title G�,1lIIU[L
WSignature
DOH 1555(07/18)pi of 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#