Secone, Margaret IR it gob
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Margaret A. Secone Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 17, 2018 85 War or Dates N/A
Place of Death Hospital, Institution or
WCity, Town or Village City of Plattsburgh Street Address Pine Harbour Assisted Living
a Manner of Death 0 Natural Cause 0 Accident ❑Homicide 0 Suicide 0 Undetermined ri Pending
VCircumstances Investigation
LEE Medical Certifier Name Title
#a Alison J. Guile MD
Address
Plattsburgh, NY
Death Certificate Filed District Number Register Number
City, Town or Village City of Plattsburgh 901 c 143
El Burial Date Cemetery or Crematory
❑Entombment May 21, 2018 Pine View Crematory
Address
jjCremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
2 ❑and/or Address
I.Z. Hold
to
0 Date Point of
011.❑Transportation Shipment
L by Common Destination
Carrier
❑Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Wilcox & Regan Funeral Home 01821
Address
11 Algonkin Street, Ticonderoga, NY 12883
Name of Funeral Firm Making Disposition or to Whom
I.- Remains are Shipped, If Other than Above
Address
Cr
W.
a' Permission is hereby granted to dispose of the human rem s described above as indi' ated.
Date Issued May/M 2018 Registrar of Vital Statistics ,,,r,�,f
(signature)
District Number 901 Place City of P attsburgh
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
11.1 Date of Disposition Cf 1 l d Place of Disposition Em � -to--
2 (address)
ILI
to
i (section) 1 (lot numb (grave number)
ci Name of Sexton or Person in Charge of Premises rhnr.JLfi
I(please print)
l Signature 04 Title lPK 't`)7IA-
(over)
DOH-1555 (02/2004)