Harris, Patricia Ann , # 6,4
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Patricia Ann Harris Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/06/2022 71 Years War or Dates
1..,. Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
UJ
O Manner of Death Natural Cause Accident []Homicide []Suicide (Undetermined []Pending
ILJ
0 I 1Circumstances I 'Investigation
U
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
City,Town or Village 5601 408
R
Burial Date Cemetery,Crematory or Facility Name
08/08/2022 Pine View Crematory
Entombment Address
▪Cremation Queensbury Town,New York
▪Donation
ZO 1-7 Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
a. Date Point of
U) Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
[]Disinterment
❑Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway, Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
j— Remains are Shipped,If Other than Above
5 Address
Q
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/08/2022 Registrar of Vital Statistics 9Megan Wolin(ECectronicaC(ySigned)
(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:
Z Date of Disposition $('( 22 Place of Disposition TIA,P yti.. ., Zif'r
W
2 (address)
W
NCC (section) flat number/ (grave number)
0 Name of Sexton or Person in Charge off ises
r't .e ft
//� ( ease print) /�,, 77�/�
W Signature �� 1 Title c r7/6in }1�1C..
DOH-1555(07/t8)p 1 of 2
P, r r
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#