Whalen, Patrick M ( )
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Patrick M.Whalen Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/26/2023 73 Years War or Dates
Place of Death Hospital,Institution or
Z
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
CI Manner of Death ❑X Natural Cause Accident Homicide Suicide ❑Undetermined Pending
W Circumstances Investigation
C.)
Medical Certifier Name Title
David Foote MD
Address
340A Main Street,Hudson Falls Village,New York 12839
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 555
riBurial Date Cemetery,Crematory or Facility Name
12/01/2023 Pine View CemeteryEl
Entombment Address
Cremation Queensbury Town,New York
I.Donation
O■Removal Date Place Removed
and/or and/or Held
i Hold Address
N
s
Transportation Date Point of
mil by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Date Cemetery Address
EllReinterment
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
_ Remains are Shipped,If Other than Above
1 Address
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/29/2023 Registrar of Vital Statistics Megan Wolin(ECectronically Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordanceorce with this permit on: /
Date of Disposition \a.\ a3 Place of Disposition l ti x. \i 420 C�v i . f Y y la6o�
W (address)
/
W "-f /(Curl 1 3 -i . 1
rz (section) llotyrgiber: (grave number)
S Name of Sexton or Person in Charge of Premises6:::kr)
n t_"
(please print)
Jd
W Signature • Title �)�
4.
DOH-1555(07/18)p 1 of 2
.. LL !
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#
CAVERLY
Lot No. 13
Address' Section No. D
West Mountain Road, Queensbury, NY 12804
Owner Lawrence & Dorothy Caverly Plot Mohican
Date 11/6/91
Approx . 67 Superficial ft. @
Location Bounded on North by Bell , South by Caverly, East by Vacant ,
West by Freeman.
Corner Posts
Remarks
Deed No. (and changes) 2390
Payment Record Paid in Full 11/6/91
Record of Interments {J \\ aLs,
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Form No. 01
WHALEN
NAME Patrick M Whelen JF) Age: 73
Lot Owner: Lawrence & Dorothy—Caverly
Lot# Mohican 1 3—D Grave# 1
Case: Concrete
Died: 11 .26 .23 Interred: 1 2. 1 .2 3
Funeral Home: Regan Denny Stafford
Cemetery: Pine View