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NEW YORK STATE DEPARTMENT OF HEALTH —Bureau of VitaL Records Burial - Transit Permit
Name First Middle Last Sex
Patricia S Winch Female
Date of Death Age If Vete-an of U.S.Armed Forces,
03/13/2023 76 Years War or Dates
ZPlace of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death E Natural Cause nAccident ri Homicide nSuicide nUndetermined nPending
UI (Circumstances I Investigation
MI Medical Certifier Name Title
CI Mathew Varughese DO
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 147
BurialR
Date Cemetery,Crematory or Facility Name
03/17/2023 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
OZ❑Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
d. Date Point of
V)nTransportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
riDisinterment
Date Cemetery Address
1 Reinterment
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
H Remains are Shipped,If Other than Above
5 Address
Q
W
O Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/17/2023 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:
I—
Z
Z Date of Disposition 312,I i;3 Place of Disposition u�g (address)
W
CO
Q (section) X (lot number) (grave number)
O Name of Sexton or Person in Ch of Premises r,�Q(,� t11-
Z /p!ase print/
W Signature Title
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DOH-1555(07/18)p 1 of 2
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Public Health Law Sec. 4145(2b)
Receipt
11
Human remains of ;' delivered on , 20
•
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#