Keenan, Patricia Ann f .
[ 1— ) #c12
NEW YORKSTATE DEPARTMENT OF HEALTH .._, Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Patricia Ann Keenan Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/22/2022 86 Years War or Dates
F Place of Death Hospital,Institution or
Z City,Town or Village Hudson Falls Village Street Address 97 Pearl Street, Hudson Falls Village, New York 12839
W Manner of Death Undetermined nPending
ID Natural Cause Accident Homicide Suicide
W I I Circumstances Investigation
W Medical Certifier Name Title
G Robert Lemieux Coroner
Address
415 Lower Main Street,Hudson Falls Village,New York 12839
Death Certificate Filed Village Of Hudson Falls District Number Register Number
City,Town or Village 5726 45
Burial Date Cemetery,Crematory or Facility Name
11/28/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
H Hold Address
CO
0
Date Point of
N ETransportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
0 Reinterment
Date Cemetery Address
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
1— Remains are Shipped,If Other than Above
N Address
CC
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/28/2022 Registrar of Vital Statistics Cynthia Bardin(ECectronically Signed)
(signature)
District Number 5726 Place Village Of Hudson Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: �
H
W Date of Disposition I 1131,1 i;Z Place of Disposition (� t.. - ��
Cl) address)
ILI
(section) (lot number) \ (grave number)
O Name of Sexton or Person in of Premises �' ' '°v �' <—'t�""v`�
Q Charge �vlease print)
W Signature L"' ( Title l��
DOH-1555(07/18)p 1 of 2
7, A64 4
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named.o nhuiial permit
Official Funeral Directors Reg. or License#