Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Goetz, Patricia M
#LIB NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patricia M.Goetz Female Date of Death Age If Veteran of U.S.Armed Forces, 01/10/2024 81 Years War or Dates H Place of Death Hospital,Institution or W City,Town or Village Kingsbury Town Street Address 621 Vaughn Road, Kingsbury Town, New York 12839 W Manner of Death E Natural Cause Accident Homicide Suicide Undetermined Pending C.) Circumstances Investigation Medical Certifier Name Title Rita All NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Kingsbury District Number Register Number City,Town or Village 5762 2 nBurial Date Cemetery,Crematory or Facility Name 01/10/2024 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation Removal Date Place Removed and/or and/or Held H Hold Address 0 td. Date Point of (/)OTransportation Q by Common Shipment Carrier Destination Date Cemetery Address nDisinterment Reinterment Date 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 F. Remains are Shipped,If Other than Above g Address Er CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/10/2024 Registrar of Vital Statistics Cynthia Bardin((Electronically Signed) (signature) District Number 5762 Place Town Of Kingsbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: z�j. W Date of Disposition I— ,L3 Place of Disposition ,J e ce,47 6 2 (address) W N (section) (lot number (grave number) 0 Name of Sexton or Person in Charge remis A /ir?OrJ Z (please print) W Signature Title QtQrerw DOH-1555(07/18)p 1 of 2 V - f 4 t,: 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#