Mars, Aaron NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Aaron Peter Mars Male
Date of Death Age If Veteran of U.S. Armed Forces,
1 2/08/201 6 54 years War or Dates 1 980-1 983
Place of Death Town of Hospital, Institution or
5 City, Town or Village Ticonderoga Street Address 27 Lead Hill Road
aManner of Death 0 Natural Cause El Accident El Homicide El Suicide ❑Undetermined ❑Pending
W. Circumstances Investigation
in Medical Certifier Name Title
C. Francis Varga M.D.
Address
P.O. Box 768, Lake Placid, NY 12946
iiiii Death Certificate Filed Town of District Number Register Number
City, Town or Village Ticonderoga 1 564 S 7
Oiiiii❑Burial Date Cemetery or Crematory
12/12/2016 Pine view Crematory
i ['Entombment Address
`'' ®Cremation Queensbury, New York
Date Place Removed
❑and/or Address
Removal and/or Held
�
to
Hold
0 Date Point of
0 Li Transportation Shipment
Cs by Common Destination
Carrier
El Disinterment Date Cemetery Address
Iiiiiiiii: :<::
El 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
RD Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
It
u
P' Permission is hereby granted to dispose of the human re ins described above as indicated.
'< Date Issued 1 2/1 2/201 6 Registrar of Vital Statistics L LSc.L `
signa re)
Iiil 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 n/�
tLI Date of Disposition li(1 /� Place of Disposition s 0, � [l-kroi,tr ,+-
I (address)
III
40
iX (section) (lot number) (grave number)
/ C
Name of Sexton or Person in Charge at,Premises 4'4'4 4 �+--- J11 (,
(p eise print)
Signature a Title (R K
(over)
DOH-1555 (02/2004)