D'Attilio, Rosalind NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Rosalind Grace D'Attilio Female
Date of Death Age If Veteran of U.S. Armed Forces,
Miii 0 6/2 4/201 7 68 y r s. War or Dates No
} Place of Death Town of Hospital, Institution or Heritage Commons
5 City, Town or Village Street Address Residential Health Care
Ticondero a
• Manner of Death E9 Natural Cause 11 Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
lJ Circumstances Investigation
W. Medical Certifier Name Title
O Richard McKeever M.D.
Address
1019 Wicker Street, Ticonderoga, New York 12883
Mi Death Certificate Filed Town of District Number Register Number
Ni City, Town or Village Ticonderoga 1 564 22
s<`['Burial Date Cemetery or Crematory
06/30/2017 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York
Date Place Removed
Removal and/or Held
and/or Address
="` Hold
O Date Point of
t Transportation Shipment
a by Common Destination
Carrier
Q Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
ii: Permit Issued to Registration Number
Oa Name of Funeral Home Wilcox & Regan funeral home 01 821
151!M Address
in 11 Algonkin St. , Ticonderoga, New York 12883
M. Name of Funeral Firm Making Disposition or to Whom
1 Remains are Shipped, If Other than Above
a Address
CC
Cu
Permission is hereby granted to dispose of the human re a s describ ab e as indicated.
Date Issued 6/24/201 7 Registrar of Vital Statistics ,�
(si ature)
District Number 1 564 Place Town of Ticonderoga
`, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
3 Place of Disposition j g0-�' s cP
Cu• Date of Disposition 7 ill p ^
2 (address)
Cu
In
CC (section) /' lot number) (grave number)
Ci Name of Sexton or Person in Charge of Premises ` ht 5040
g (ple4se print)
Ui Signature
/ Title C13�'��'(
(over)
DOH-1555 (02/2004)