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Noxon, Patricia Ann if t LF) -tt 5"5- NEW YORK STATE DEPARTMENT OF HEALTH \<__/ Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patricia Ann Noxon Female Date of Death Age If Veteran of U.S.Armed Forces, 01/13/2024 79 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc W Manner of Death g � �Natural Cause Accident �Homicide Suicide Undetermined �Pendin W Circumstances Investigation U W Medical Certifier Name Title CI Rick Teetz MD Address 131 Lawrence St,Saratoga Springs,New York 12866 Death Certificate Filed City Of Saratoga Springs District Number Register Number City,Town or Village 4501 28 Burial Date Cemetery,Crematory or Facility Name IIIIM 01/16/2024 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation ZZ❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 O. Date Point of (/)ETransportation Shipment p by Common Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom i— Remains are Shipped,If Other than Above S Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/16/2024 Registrar of Vital Statistics Oil-Con Moran(ECectronica1Ty Signed) (signature) District Number 4501 Place City Of Saratoga Springs I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition I 116179 Place of Disposition 7p,St'r‘- ( i mr1` a- LLJ 2 (address) W NCC (section) i I f/ot number) (grave number) 11 a Name of Sexton or Person in Charge of a ises ;2 ' Q`1yl� i � f Z � /please print) W Signature ;' Title �� � DOH-1555(07/18)p 1 of 2 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#