Porter, Patricia Jean 0,175,
.., ,- bi- i
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Patricia Jean Porter Female
Date of Death Age If Veteran of US.Armed Forces,
01/02/2024 81 Years War or Dates
E Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
p Manner of Death ®Natural Cause Accident 0 Homicide Suicide Ei Undetermined Pending
U Circumstances Investigation
0IU Medical Certifier Name Title
Wendy Steinhacker PA
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 1
RBurial Date Cemetery,Crematory or Facility Name
01/03/2024 Pine View Crematory
Entombment Address
®Cremation Queensbury Town,New York
Donation
OZ❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
a Date Point of
U) Transportation
p by Common Shipment
Carrier Destination
EjDisinterment Date Cemetery Address
IDReinterment 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
H Remains are Shipped,If Other than Above
2 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/03/2024 Registrar of Vital Statistics Megan Nan(ECectronicafySigned)
(s gnature)
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:
I—
W Date of Disposition 1 (5-(z9 Place of Disposition .Prrvir-„J G ITD�es�2 (address)
W
N CC (section) J(lot nuwter) (grave number)
SName of Sexton or Person in Charge o Pr mises '^ H
Z (pl print)
W Signature Title f i1
DOH-1555(07/18)p 1 of 2
• 2 r 0 1 b 8 1 8
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# - .