Whitty, James NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Miii Name First Middle Last Sex
James Robert Whitty Male
iiiiia Date of Death Age If Veteran of U.S. Armed Forces,
12/04/2016 89 yrs. War or Dates No
14, Place of Death Town of Hospital, Institution or
City, Town or Village Ticonderogaiii Street Address 8 Park Avenue
Manner of Death®Natural Cause E Accident E Homicide 0 Suicide 0 Undetermined OPending
114. Circumstances Investigation
iii Medical Certifier Name Title
Glen Chapman M.D.
IIN Address
P.O. Box 29, Ticonderoga, NY 12883
gilil Death Certificate Filed Town of District Number Register Number
iiiii City, Town or Village Ticonderoga 1 564 56
<!El Burial Date Cemetery or Crematory
1 01 6 Pine View Crematory
r' ['Entombment Address
®Cremation Queensbury, New York
Date Place Removed
Z El❑Removal and/or Held
and/or Address
i= Hold
CO
0 Date Point of
tl
❑Transportation Shipment
.. by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Wilcox & Regan funeral home 01 821
Eiiiii Address
11 Algonkin St. , Ticonderoga, New York 12883
IDI Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
It
ILI
l` Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 1 2/0 7/201 6 Registrar of Vital Statistics t cad
(si ature)
iie 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:
ILI Date of Disposition/2//)`/(� Place of Disposition Pi/tL G.1 et.J 6 re",,/er/
iz l ! (addre s)
w
U)
ilk (section)` ` (lot number) (grave number)
Ci Name of Sexton Person in Charge of Premises v K /i«vi , ,7L1�-X.e
(please print)
W. / -- ---..._._ Gle.Ile, e
Signature .��v �� Title
(over)
DOH-1555 (02/2004)