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Hayes, Patricia May NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Patricia May Hayes Female Date of Death Age If Veteran of U.S.Armed Forces, 03/10/2024 90 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 198 Bluebird Rd,Moreau Town, New York 12803 • Manner of Death Undetermined Pending Natural Cause Accident Homicide Suicide Circumstances Investigation W Medical Certifier Name Title CI Sandita Seecharan MD Address 325 Main street,Hudson Falls Village,New York 12839 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 15 Burial Date Cemetery,Crematory or Facility Name 03/14/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York EiDonation ❑Removal Date Place Removed and/or and/or Held F- Hold Address O Date Point of (/)n Transportation Shipment p by Common Carrier Destination 111 Disinterment Date Cemetery Address O Reinterment 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 1— Remains are Shipped,If Other than Above 2 Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/14/2024 Registrar of Vital Statistics Brenda Mutter(ECectronica((ySigned) (signature) District Number 4562 Place Town Of Moreau I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 3I t S 129 Place of Disposition r I y-,1 I p'A TAVA—. (address) W N (section) j (lot number) (grave number) 0 Name of Sexton or Person in Charge of P ises ;.%‘y►t--• ),Z `rr Z (phase print) W Signature _ Title 6 P°A�fZ 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#