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Trainor Jr., Herbert )1 it) Pp NEW YORK STATE DEPARTMENT OF HEALTH -, Vital Records Section Burial - Transit Permit M.i Name First Middle Last Sex Herbert A. Trainor, Jr. Male ig,i! Date of Death Age If Veteran of U.S.Armed Forces, 11 /0 8/2 017 67 yrs. War or Dates No Place of Death Hospital, Institution or Heritage Commons Town of City, Town or Village Ti r•nnr�arnc Street Address Residential Health Care Manner of Death 0 Natural Cause El Accident ci Homicide El Suicide riUndetermined 0 Pending Circumstances Investigation IL Medical Certifier Name Title Kathleen P_ Hnec -is _FL.D_ Address 1019 Wicker Street, Ticonderoga, New Yor 17883 Death Certificate Filed Town of District Number Register_/ Number ;;< City, Town or Village Ticonderoga 1 5 A 4 17 61 ['Burial Date Cemetery or Crematory 11 /09/2017 Pine View Crematory i` ['Entombment Address ®Cremation Queensbury, New York Date Place Removed ❑Removal and/or Held 14, and/or Address lfi Hold Date Point of Q Transportation Shipment 42 by Common Destination Carrier ❑Disinterment Date . Cemetery Address Q Reinterment Date Cemetery Address liiiiiPermit Issued to Registration Number Mi Name of Funeral Home Wilcox & Regan funeral home 01 821 Address 11 Algonkin St. , Ticonderoga, New York 12883 Tip Name of Funeral Firm Making Disposition or to Whom `- Remains are Shipped, If Other than Above ff Address Permission is hereby granted to dispose of the human re a s describ ab• - as indicated. 1 1 /9/201 7 � � iiiiiia Date Issued Registrar of Vital Statistics (- • -ture) mg District Number 1 564 Place Town of Ticonderoga I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 14,1 Date of Disposition (I i (t( I(� Place of Disposition k .,., l ©t� (address) 41 1A III (section) got number) (grave number) II Name of Sexton or Person in Charge of Prem. es r+d 1+r S 0,146 (pleas print)iiiii Signature '/J`/ Title tiiiillOft- (over) DOH-1555 (02/2004)