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Connors, Robert ZO3 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Robert F.Connors Male Date of Death Age If Veteran of U.S.Armed Forces, 03/06/2018 81 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Ticonderoga Town Street Address Heritage Commons Residential Health Care • Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Richard Mckeever MD Address 1019 Wicker St,Ticonderoga Town,New York 12883 Death Certificate Filed District Number Register Number City, Town or Village Ticonderoga 1564 10 0 Burial Date Cemetery or Crematory 03/07/2018 Pine View Crematory El Entombment Address ®Cremation Queensbury, New York Date Place Removed ❑• Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier ❑Disinterment Date Cemetery Address • ❑Reinterment Date Cemetery Address 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 Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/07/2018 Registrar of Vital Statistics 7onya M'Thompson(E(ectronica1Ty Signed) (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: • Date of Disposition 3)q ilq Place of Disposition f:‘,1/./ (' i.-- (address) (section) A(lot number) (grave number) Name of Sexton or Person in Charge of remises l nh i 1""' /' (Pl Pit) _ • Signature G� Title I� tlplft_ (over) DOH-1555 (02/2004)