Loading...
Breason,Patricia Ann .�,,. . . # 37c NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patricia Ann Breason Female Date of Death Age If Veteran of U.S.Armed Forces, 04/04/2023 90 Years War or Dates 1... Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 11.1 p Manner of Death ❑X Natural Cause Accident ❑Homicide 0Suicide FlUndetermined riPending W Circumstances Investigation W Medical Certifier Name Title p John Quaresima MD 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 179 Burial Date Cemetery,Crematory or Facility Name 04/10/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation ZO 0 Removal Date Place Removed and/or and/or Held F- Hold Address N 0 Date Point of CA❑Transportation Shipment p by Common Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address 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 2 Address CC W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/06/2023 Registrar of Vital Statistics Megan Wolin g(ectronicalTySigned) (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: F— 'I Z Date of Disposition Lf IZ I Z3 Place of Disposition r v u..- J UJ (address) W Cl) (section) 4, (lot number) (grave number) CC g Name of Sexton or Person in Charge of P ises �" 41ff (pa se print/ Z W Signature / Title l omfin'p DOH-1555(07/18)p 1 of 2 _ , 1 C1 few J 4 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#-