Patterson, Anne l (2) - . . # egg
NEW YORKSTATE DEPARTMENT OF HEALTH "" Burial - Transit Permit
Bureau of Vital Records
Name First
Middle Last I Sex
Female
Anne L Patterson
Date of Death Age If Veteran of U.S.Armed Forces,
06/14/2022 82 Years War or Dates
Place of Death Hospital,Institution or
�"' Street Address Saratoga Hospital
Z City,Town or Village Saratoga Springs Undetermined ❑Pending
WDeath
Q Manner of Natural Cause Accident Ei]Homicide Suicide Circumstances Investigation
W
U Title
Q Medical Certifier Name DO
Timothy Waters
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed City Of Saratoga Springs District Number Register Number367
City,Town or Village 4501
HBurial Date Cemetery,Crematory or Facility Name
06/16/2022 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Date Place Removed
O❑Removal and/or Held
Hand/or
Hold Address
0
Point of
13.
• Transportation Date Shipment
O by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
0 Reinterment
Permit Issued to Registration Number
Name of Funeral Home
Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
p- Remains are Shipped,If Other than Above
2 Address
IX
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/15/2022 Registrar of Vital Statistics Dillon Moran(Electronically Signed)
(signature)
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2 t ILA
Date of Disposition �Il'�1ZL Place of Disposition na1(�
W (address)
W (grave number)
CC
(section) iiip.t-tk—
(lot number)0 4rt
Name of Sexton or Person in Charge• 'remises ease print)
z j �j 104 j
III Signature Title
DOH-1555 07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0
Receipt
Human remains of ' _a delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#