Abare, Tina NEW YORK STATE DEPARTMENT OF HEALTH
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Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Female
Tina Leean Abare
Date of Death Age If Veteran of U.S. Armed Forces,
1 1 /29/2018 41 yrs. War or Dates No
Place of Death Town of Hospital, Institution or
it City, Town or Village Ticonderoga Street Address Moses-Ludington Hospital
a Manner of Death 0 Natural Cause 0 Accident 0 Homicide []Suicide �Undetermined Pending
I Circumstances Investigation
fij
Medical Certifier Name Title
Eric Gorman M.D.
Address
CVPH, 75 Beekman Street, Plattsburgh, NY 12901
Death Certificate Filed Town of District Number Register Number
Mii City, Town or Village Ticonderoga 1 564 '/ 5—
A.EIBurial Date Cemetery or Crematory
12/03/2018 Pine View Crematory
liiiii ['Entombment Address
`'.®Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
l'il..: and/or Address
t. Hold
to
0 Date Point of
0 Transportation Shipment
3 by Common Destination -
Carrier
: Q Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
oi.: Liiig Permit Issued to Registration Number
0. Name of Funeral Home Wilcox & Regan funeral home 01 821
Address
11 Algonkin St. , Ticonderoga, New York 12883
Name of Funeral Firm Making Disposition or to Whom
:- Remains are Shipped, If Other than Above
IAddress •
' Permission is hereby granted to dispose of the human rem d scribed�a�' ve indicated.
Date Issued 12/2/2 01 8 Registrar of Vital Statistics •/ l? ems/ r / �`I/ /�(.'h 1 --
i
(si na re)
District Number 1 5 64 Place Town of Tic erog'a
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
AI Date of Disposition /2I3111 Place of Disposition (,,,J.,,,r gv...1-0.---
2 (address)
aa
(section) (lot number (grave number)
0 Name of Sexton or Person in Charge of Pre ises Fy I Coodt
i (p/ee pnnSignature Title -00 L
(over)
DOH-1555 (02/2004)