Andrus, Patricia Anne ��
NEW YORKSTATE DEPARTMENT OF HEALTH �� Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Patricia Anne Andrus Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/11/2023 87 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Ticonderoga Town Street Address Elderwood at Ticonderoga
WManner of Death Undetermined Pending
Natural Cause Accident Homicide Suicide
Circumstances Investigation
W Medical Certifier Name Title
G Nathalie Abisror MD
Address
1019 Wicker St,Ticonderoga Town,New York 12883
Death Certificate Filed Town Of Ticonderoga District Number Register Number
City,Town or Village 1564 27
Burial Date Cemetery,Crematory or Facility Name
04/26/2023 Pine View Cemetery
_Entombment Address
Cremation Queensbury Town,New York
Donation
(soRemoval Date Place Removed
and/or and/or Held
Hold Address
0
a Date Point of
<!) Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
pReintermentDate 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
Remains are Shipped,If Other than Above
S Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/13/2023 Registrar of Vital Statistics Tonya M Thompson(E1 ctronically Signed)
(signature)
District Number 1564 Place Town Of Ticonderoga
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition at,. a3 Place of Disposition at L .c <e Z,Rp d tieens\a_1 � • `Ji/ 1 38
W 6
2 (address)
w � .519 ACC
CC inns (lot numb / (grave number)
gName of Sexton or Person in Charge of Premi _ �-- )fn i e (DC ciCR '
(please/print)
rint) / J
W Signature ����f.L. rC. '4 Title i R/n"j�enu�"7Z
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 61 2975
Receipt
Human remains of delivered on , 20
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• e View Cemetery Representing the funeral home named on burial permit
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Funeral Directors Reg.or License#
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Lot No. 56 A
Address -Rn3 Ro 1 159, (lens Falls, ?'.v, 12801 Section No.
Owner Patricia Andrus Plot
Mohawk
Date 2/15/85
Ao:rex 67 Superficial ft. @
Location Bounded North by 2yers, South by Vacant, vast by Vacant P• Cordon, !rest by `Ta.cant.
Corner Posts
Remarks
Deed No. (and changes) 1909
Payment Record maid in Full 2/15/85
Record of Interments Vic 4ti7"
Forrest William Andrus
2/15/85
2 I �4kRicio Ar,,n Anc\c-u_ L•t•ate• a.6
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Form No. 01
Andrus I�
NAME Patricia Anne Andrus/Age: 87
Lot Owner: Patricia Andrus
Lot# Mohawk 56 A Grave# 2
Case:Concrete
Died: 4 . 1 1 .2 3 Interred: 4.26.23
Funeral Home: Carleton Fh
Cemetery: Pine View