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Denton, George NEW YORK STATE DEPARTMENT OF HEALTH L 1 123 Vital Records Section Burial - Transit Permit Name First Middle Last Sex George Philip Denton Male Date of Death Age If Veteran of U.S. Armed Forces, 10/10/2018 78 Years War or Dates 1959-1965 Place of Death Hospital, Institution or al City, Town or Village Elizabethtown Town Street Address Essex Center For Rehabilitation And Healthcare Q. Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation ' Medical Certifier Name Title Jonathan Waldman MD Address 81 Park Street,Elizabethtown Town,New York 12932 Death Certificate Filed District Number Register Number City, Town or Village Elizabethtown 1552 61 El Burial Date Cemetery or Crematory 10/15/2018 Pine View Crematory 34 Entombment Address V®Cremation Queensbury, New York Date Place Removed ❑Removal and/or Held VP and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address ❑Renterment Date Cemetery Address Permit Issued to Registration Number =T. 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 Address �_ Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/12/2018 Registrar of Vital Statistics Janet'E Cross(ECectronically Signed) -' (signature) District Number 1552 Place Elizabethtown, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition milt is Place of Disposition fr,,1L t' .tz_ (address) (section) (lot n ber) (grave number) Name of Sexton or Person in Charge of P emises plkitt (�easeprt 6Signature Title tit0014 rka (over) DOH-1555 (02/2004)