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Best, Donald NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last 1 Sex Donald T_ Bcst Male Date of Death Age If Veteran of U.S. Armed Forces, 11110111 03/05/2017 86 yrs . War or Dates 1 952-1 954 Place of Death Town of Hospital. Institution or Street Address 8843 Lake Shore Drive ID Z City, Town or Village Hague',© Manner of Death Natural Cause Accident 0 Homicide Suicide Undete_rmined Pending i Circumstances Investigation •11,1jMedical Certifier Name Title ; y Glen Chapman M.D. Address P.O. Box 29, Ticonderoga, New York 12883 110111 Death Certificate Filed Town of District Number Register Number City, Town or Village Hague 5653 3 Date Cemetery or Crematory 1Burial 03/07/2017 Pine View Crematory Address -- 1 Cremation Queensbury, New York Date I Place Removed 2 n Removal and/or Held L. and/or I Address L Hold Q Date Point of N _Transportation i Shipment a by Common • Destination Carrier C Disinterment 1 Date Cemetery Address • n Reinterment 1 Date Cemetery Address - Permit Issued to Registration Number Name of Funeral Home Wilcox & Regan funeral home • 01 821 Address 11 Algonkin St. , Ticonderoga, New York 12883 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped, If Other than Above 11014 Address s Permission is hereby granted to dispose of the human remains described above as indicated. . Date Issued 3/7/2 01 7 Registrar of Vital Statistics • if'it l') i( ••t )l't t i r i , t -vj2 t.i { (signatur4) L1 District Number 5653 Place Town of Hague I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 3/Sin Place of Disposition 'ztJ i /,iirtile, 2 (address) La U CC (section) , (Jot number) ( (grave number) 0 Name of Sexton or Person in Charge of Premises t., i .Al u t 2 ,, (please print) Signature ._'LQ, Title /tet=Mt}'IX DOH-1555 (10/89) p. 1 of 2 VS-61