Meade, Laura NEW YORK STATE DEPARTMENT OF HEALTH ( 30
Vital Records Section ` , Burial - Transit Permit
Name First Middle Last Sex
Laura S. Meade Female
Date of Death Age If Veteran of U.S. Armed Forces,
7/27/2013 86 yrs- War or Dates No
} Place of Death Town of Hospital, Institution or Heritage Commons
IIICity, Town or Village Ticonderoga Street Address Residential Healthcare
Manner of Death E9 Natural Cause Accident Homicide ❑Suicide 0 Undetermined Pending
Circumstances Investigation
Ej
la Medical Certifier Name Title
CI
Glen Chapman M.D.
Address
P.O. Box 29, Ticonderoga, NY 12883
Death Certificate Filed Town of District Number Register Number
City, Town or Village Ticonderoga 1 564
DBurial Date Cemetery or Crematory
['Entombment Address
Pine View Crematory
Address
Aiii®Cremation Queensbury, New York •
" Date Place Removed
Z El Removal and/or Held
2 and/or
1 Address
Cl)
Hold
0 Date Point of
i1 0 Li Transportation Shipment
L by Common Destination
gii Carrier
El Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Wilcox & Regan funeral home 01 821
aii Address
iiiii 11 Algonkin St. , Ticonderoga, New York 12883
ii Name of Funeral Firm Making Disposition or to Whom •
Remains are Shipped, If Other than Above
• Address
ill
97 Permission is hereby granted to dispose of the human remains ribed ab as i - ted.
Date Issued 7/29/201 3 Registrar of Vital Statistics
(signs )
gli District Number 1 564 Place Town of Ticonderoga
al I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
111• Date of Disposition 1- 0- „�.� C.rt3 Place of Disposition - t:4A cf Now-
a
(address)
lu
CC (section) (lot number) (grave number)
0
3 Name of Sexton or Perso in Charge of Pr mises Ai) 5I
2 i (p/ se print)
l Si nature L-- Title c aE tt
(over)
DOH-1555 (02/2004)