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Ingersoll, Patricia Gail
k....' 4 •V CHL:.---- NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patricia Gail Ingersoll Female Date of Death Age If Veteran of U.S.Armed Forces, 06/21/2023 61 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Glens Falls Street Address Glens Falls Hospital ILI WManner of Death El Natural Cause Accident ❑Homicide nSuicide Undetermined ri Pending 0 Circumstances Investigation ILI Medical Certifier Name Title CI Lynn Keil PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 303 FRBurial Date Cemetery,Crematory or Facility Name 06/21/2023 Pineview Crematorium Entombment Address ©Cremation Queensbury Town,New York DDonation 2 Date Place Removed 4❑Removal and/or and/or Held 0 Hold Address CO Transportation Date Point of Z' by Common Shipment Carrier Destination Date Cemetery Address El Disinterment Date Cemetery Address I:I Reinterment Permit Issued to Registration Number Name of Funeral Home Mason Funeral Home 01117 Address 18 George St Po Box 277,Fort Ann,New York 12827-0277 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above S Address C 'U a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/21/2023 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: Z Date of Disposition lr)4173 Place of Disposition 'rl. k-- aa_ a. (address) Lu E, (section) %if. ,(`loot/number) (grave number) 8 Name of Sexton or Person in Charge of Premises R /g) �(pleaseprint) litSignature Cal Title f� m ( �l DOH-1555(07/18)p 1 of 2 ell 7O5 9. Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 °'' Pine View Cemetery Representing the funeral home named can h ria1 permit Official Funeral Directors Reg.or License#,.