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Steele, Joanann NEW YORK STATE DEPARTMENT OF HEALTH /OF Vital Records Section Burial - Transit Permit Name First Middle Last Sex a k Joanann Steele Female Date of Death Age If Veteran of U.S. Armed Forces, 08/20/2018 56 Years War or Des F Place of Death Hospitarnistitution or City, Town or Village Ticonderoga Town Street Address Heritage Commons Residential Health Care 0 Manner of Death©Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title 0 Glen Chapman MD Address 1019 Wicker St,Ticonderoga Town,New York 12883 Death Certificate Filed District Number Register Number City, Town or Village Ticonderoga 1564 30 ._ ❑Burial Date Cemetery or Crematory 08/22/2018 Pine View Crematory ❑Entombment s Address ®Cremation Queensbury, New York Date Place Removed in Removal and/or Held and/or Address tai Hold Date Point of frill❑Transportation Shipment by Common Destination Carrier li le, ❑Disinterment Date Cemetery Address �, ❑Reinterment Date Cemetery Address r' Permit Issued to Registration Number Name of Funeral Home Wilcox&Regan 01821 , Address 11 Algonkin St,Ticonderoga,New York 12883 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above g Address ,r`r Permission is hereby granted to dispose of the human remains described above as indicated. 'i Date Issued 08/21/2018 Registrar of Vital Statistics Tonya 911Tiompson(ECectronicalTySigned) (signature) -` District Number 1564 Place Ticonderoga, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: tu Date of Disposition ,e}-18 Place of Disposition p; ✓i c 0f toic 'Ic r)/ (address) 0 ill (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises cICA.0 )/ SV,,►r s (please print) l;Ll Si nature/0,0_____.ikr. ,/ Title C,Lnra-k f 9 (over) DOH-1555 (02/2004)