Towne, Stephanie itilD
NEW YORK STATE DEPARTMENT OF HEALTH ' is -Burial Transit
Vital Records Section ua t Permit
Name First Middle Last Sex
Stephanie Jo Towne Female
Date of Death Age If Veteran of U.S. Armed Forces,
02/01 /2018 64 yrs. War or Dates No
Place of Death Town o f Hospital, Institution or
.41 City, Town or Village Ti condprnga Street Address 28 Outlet Drive
tul
Manner of Death Jj Natural Cause Accident D Homicide El Suicide 0Undetermined Q Pending
Circumstances Investigation
MI Medical Certifier Name Title
/ L
Address a
Col earey Rbad ' tiee, n .5 u jir J.t y i g01-1-
Death Certificate Filed Town of District Number �e ister Number
City, Town or Village TiconciPrnga 1 564 9
❑Burial Date Cemetery or Crematory
DEntombment 02/05/2018 Pine V Q�--r'_r er
Address y
®Cremation Queensbury, New York
Date Place Removed
r Removal
❑ and/or Held
and/or Address
Hold
Date Point of
d Q Transportation Shipment
A by Common Destination
Carrier _
Q Disinterment Date Cemetery Address
Q 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
•
fitil
::::: Permission is hereby granted to dispose of the human re a' s described boy- ,s indicated.
Date Issued 2/2/2018 Registrar of Vital Statistics
(sig lr re)
District Number 1 564 Place Town of Ticon roga
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
mod,
1 Date of Disposition L/fi ks Place of Disposition ?NIL- A
(address)
1 As
(section) (lot number (grave number)
2 Name of Sexton or Person in Charge of Pre - es � .�,+
i d (passe prinlf
Signature Title 1419) -
(over)
DOH-1555 (02/2004)