Rathbun, Patricia Anne NEW YORKSTATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Patricia Anne Rathbun Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/29/2022 77 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Granville Village Street Address Granville Center for Rehabilitation and Nursing
p Manner of Death II Natural Cause Accident Homicide Suicide Undetermined FlPending
W Circumstances Investigation
W Medical Certifier Name Title
W Thomas Kandora MD
Address
17 Madison St,Granville Village,New York 12832
Death Certificate Filed Village Of Granville District Number Register Number
City,Town or Village 5725 33
Burial Date Cemetery,Crematory or Facility Name
08/02/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
D Removal Date Place Removed
and/or and/or Held
F- Hold Address
O
0.. Date Point of
(I)❑Transportation
by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
CC
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/01/2022 Registrar of Vital Statistics `ljchariiRu6erts(ECectronica(lySigned)
(signature)
District Number 5725 Place Village Of Granville
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
fW Date of Disposition g 12 I7,2 Place of Disposition
2 (address)
W
to°` (section) (lot number) C (grave number)
,4 It
Name of Sexton or Person in Charge of ices
please print/ y�- ���/�
iW fr m��"Signature r— _ Title
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b) �t �
Receipt
Human remains of ; , delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or L1zenge#