Neville, Patricia A ftil
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Patricia A.Neville Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/27/2023 72 Years War or Dates
F_ Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W
p Manner of Death 121 Natural Cause Accident Homicide OSuicide Undetermined ❑Pending
W
C.) Circumstances Investigation
W Medical Certifier Name Title
CI Julian Marynczak PA
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 55
Burial Date Cemetery,Crematory or Facility Name
01/30/2023 Pine View Crematory
Entombment Address
IIICremation Queensbury Town,New York
Donation
0 0 Removal Date Place Removed
and/or and/or Held
M— Hold Address
N
0
d 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 Brewer Funeral Home Inc 00211
Address
24 Church Street PO Box 500,Lake Luzerne, New York 12846
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Other than Above
2 Address
CC
tiJ
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/30/2023 Registrar of Vital Statistics Megan Nolin(Electronically Signed)
(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:
H y
Z Date of Disposition i 130 IT) Place of Disposition A l %w{.. r
W
2 (address)
CC UJU)
(section) 7//lotpu�mber/ ck'urt (grave number)
to Name of Sexton or Person in Charge of Premises w
Z / (ple e print)
W Signature G Title (17 a)02
DOH-1555(07/18)p 1 of 2
t 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#