Loading...
Dobler, Carol NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transi Permit Name First Middle Last Sex Carol Ann Dobler Female Date of Death Age If Veteran of U.S. Armed Forces, 6/07/2017 74 yrs. War or Dates No ▪ Place of Death Town of Hospital, Institution or Z City, Town or Village Street Address Moses-Ludington Hospital .1 Ticonderoga O Manner of Death®Natural Cause ElAccident IIIHomicide ElSuicide ❑Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title 12 K. P. Huestis M.D. Address 1019 Wicker Street, Ticonderoga, New York 12883 Death Certificate Filed Town of District Number Register Number City, Town or Village Ti cnnriPrn a 1 564 1 9 ❑Burial Date Cemetery or Crematory ['Entombment Pine View Crematory Address y. ©Cremation Oueensbury, New York Date Place Removed K❑Removal and/or Held C? and/or w, Address Hold Cil O Date Point of 05 ❑Transportation - Shipment G by Common Destination Carrier El Disinterment Date Cemetery Address ❑Reinterment 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 Remains are Shipped, If Other than Above • Address cr I! '` Permission is hereby granted to dispose of the human re ains described above as indicated. 9 A_S- A_ _ Date Issued 6/9/2 01 7 Registrar of Vital Statistics ��ry,,) ye A_ U(signature) 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: k I.0 Date of Disposition (O I II In Place of Disposition f iiti.,.. G/� .Al-ort W (address) CA CC (section) lot number) (grave number) pName of Sexton or Person in Charge of Premises (�j, it4. . ��LMM .Z /y (ple se print) Signature wt /4 Title (-10C MI TA- (over) DOH-1555 (02/2004)