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Martin, Patricia Ann NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patricia Ann Martin Female Date of Death Age If Veteran of U.S.Armed Forces, 05/11/2023 83 Years War or Dates F— Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing WW Manner of Death Undetermined Pending El Natural Cause Accident Homicide Suicide g Circumstances Investigation WMedical Certifier Name Title O Roslyn Socolof MD Address 42 Gurney Ln,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 74 Burial Date Cemetery,Crematory or Facility Name 05/16/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZO Removal Date Place Removed and/or and/or Held H Hold Address 0 d Date Point of (!) Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/16/2023 Registrar of Vital Statistics Caroline H'((egarare Barber(ECectronicaCCy 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: Z Date of Disposition 5-jot I Z3 Place of Disposition �, /6C IJJ 2 (address) W CC CC (section) //,� (lot number) (grave number) SName of Sexton or Person in Charge of Pre ises '" L If Z 11(please print/ w 12 Signature Title DOH-1555(07/18)pi of 2 1 . 0 = r' Public Health Law Sec. 4145(2b) 1 I Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#