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Ferari, Patricia .100F tt 215 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patricia Ferari -1. Female Date of Death °t Age If Veteran of U.S.Armed Forces, 03/25/2023 65 Years War or Dates F— Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 7 Mohawk Trail,Queensbury Town,New York 12804 W Manner of Death g 0 �Natural Cause Accident Homicide Suicide Undetermined ❑Pendin W Circumstances Investigation W Medical Certifier Name Title CI Curtis Gedney MD Address 454 Glen Street,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 43 Burial Date Cemetery,Crematory or Facility Name 03/28/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held ~ Hold Address In O. Date Point of N❑Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom F. Remains are Shipped,If Other than Above a Address CC W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/27/2023 Registrar of Vital Statistics Caroline IfiCtlegarde Barber(EtectronicalTy Signed) , (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition 3)Zn ID Place of Disposition `1 i,.t/J�re�/ (sitt4'. UJ U) IE (section) dot number) (grave number) /11i exton orerson8 Name of S P in Charge of Prem. I' C t rt z �lplease print) W Title 6f ti�< Signature DOH-1555(07/18)p 1 of 2 s 16842 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#