Lansing, Patricia Ann NEW YORK STATE DEPARTMENT OF HEALTH ,� �� Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Patricia Ann Lansing Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/03/2024 81 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
CI Melody Long PA
Address
100 Park Street,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 66
X Burial Date Cemetery,Crematory or Facility Name
02/07/2024 Pine View Cemetery
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO Removal Date Place Removed
and/or and/or Held
CO Hold Address
W❑Transportation Date Point of
by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Reinterment Date Cemetery Address
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
1— Remains are Shipped,If Other than Above
2 Address
i
W
CI. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/05/2024 Registrar of Vital Statistics Megan No('n(E(ectronicalTy 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: Q
WDate of Disposition �,1,a` , Place of Disposition,, \ Lk a�`iC: i� >S l L i vt- /(�' J�
2 (address)
w mi)hat v/-\v '--\
N
R (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises �nfl t (1)c -\2A----
(please print
Z c� c �1C1.t
W Signature /� i) Title > >.+7- ,
1 DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0 - f
Receipt
Human remains of delivered on , 20
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Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
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Lot No. 14T ,
Address RD2-,Box..a20 Wes*.Mountai -c-?d-Glens Falls, N.Y. SectionNO.
Owner Mr. Mrs. William E. L insinc. Plot l'fohawk
Date `/I2 /82 ...,..A..
App 'cximat ely 400 Superficial ft. @
Location ((Vacant
Bounded Nnrth by roa d South by vaoant`East by\Brandcot by Ceiivi1k& Vacant
Corner Posts
Remarks
Deed No. (and changes) 1688
Payment Record Pa d ,� fill1l�/7�/R� For 6 Graves Additional 6 Graves Bought 6/14/82
Additional Graves Paid in Full 6/14/82
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Form No. 01
Record of Interments
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LANSING
NAME Patricia Lansing Age: el
LotOwner:William E. Lansing
Lot# Mohawk Grave# 4
Case: Concrete
Died: . a y Interred: 2 .5.2 4
Funeral Home: Regan Denny Stafford
Cemetery: Pine View