Crammond, Gerald NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last ' Sex
iiiiiii Gerald T„ Crammond Male
Date of Death Age If Veteran of U.S. Armed Forces,
0 3/1 1J201 7 78 years War or Dates 1 957-1 959
Place of Death Hospital, Institution or 35 Watts Hill Road
Town of
Z City, Town or Village Hague Street Address Silver Bay
10
Manner of Death X❑Natural Cause El Accident E Homicide El Suicide Undetermined C Pending
L Circumstances Investigation
is Medical Certifieriii„ Name Title
.L - Sarah Walton P_A_
Address
3767 Main Street, Warrensburg, NY 12885
iiiik Death Certificate Filed Town of District Number Register Number
» City, Town or Village Hague 5653 0 4
Date Cemetery or Crematory
❑Burial 03/14/2017 Pine View Crematory
. Address
< Cremation Queensbury, New York
Date Place Removed
2 C Removal , and/or Held
n and/or Address
Hold
O Date I Point of
es Q Transportation Shipment
a by Common Destination -
Carrier
:: f�Disinterment Date Cemetery Address
Reinterment Date Cemetery Address •
I .
li Permit Issued to Registration Number
Name of Funeral Home Wilcox & Regan funeral home 01 821
>= Address
im
11 Algonkin St. , Ticonderoga, New York 12883
Name of Funeral Firm.Making Disposition or to Whom .
Remains are Shipped, If Other than Above
rm. Address
A:
Mi Permission is hereby granted to dispose of the hum n re ains described ove as i ica d.
- tO__-_-)1P-SPIA
illi Date Issued 3/1 4/2 01 7 Registrar of Vital Statistics
IiI (signature
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:
if, Date of Disposition '(151i) Place of Disposition �in/OrLw Gr9mgtDcwn.,
2 (address)
to .
0
CC (section) N(lot numberS (grave number)
O Name of Sexton or Person in Charge of Premises G nrisyhti- t+i;t 1t
z ,/ (please print)
• Signature 4 Title iRktnityr J
DOH-1555 (10/89) p. 1 of 2 VS-61