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Sheets Sr., Andrew NEW YORK STATE DEPARTMENT OF HEAL" I-I . , / # Yq 2_ Vital Records Section Burial - TransitPermit Name First Middle Last Sex Andrew Truman Sheets,Sr_ Male Date of Death Age If Veteran of U.S. Armed Forces, 06/26/2017 71 yrs. War or Dates Vietnam War I Place of Death Town of Hospital, Institution or Heritage Commons WCity, Town or Village T i cnndernga Street Address Re,s i dent i a l Health Care, 12 Manner of Death®Natural Cause ❑Accident ElHomicide ElSuicide ElUndetermined ❑Pending W. Circumstances Investigation Ili Medical Certifier Name Title 0 Richard McKeever M.D. Address 1019 Wicker Street, Ticonderoga, NY 12883 Death Certificate Filed Town of District Number Register Number City, Town or Village Ticonderoga 1 564 �• ❑Burial Date Cemetery or Crematory ['Entombment06/27/2017 Pine View Crematory Address ©Cremation Queensbury, New York Date Place Removed Z Removal and/or Held 2❑and/or Address t) Hold o Date Point of c%❑ Transportation Shipment Et by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address >` Permit Issued to Registration Number 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 2 Address iti fl` Permission is hereby granted to dispose of the human remains scribed eas•indicated. Date Issued 6/27/201 7 Registrar of Vital Statistics e� I _'-- ( -gnature) 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: Z iii Date of Disposition 6 MO Place of Disposition *rev Ow C,.►m 1 cv.)..... (address) W CO CC (section) lot number) (grave number) c d Name of Sexton or Person in Charge o Premises i oicrijr, S o4bi l d 2 (pleake print) Signature /I urg, Title aw (over) DOH-1555 (02/2004)