Hinkamp, Johathan 4 . _ _'I t
NEW YORK STATE DEPARTMENT OF HEALTH t �//7
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Rev. Jonathan James Hinkamp Male
Date of Death Age If Veteran of U.S. Armed Forces,
06/21 /2016 81 yrs. War or Dates No
• Place of Death Town of Hospital, Institution or
City, Town or Village Ticonderoga Street Address Moses-Ludington Hospital
O Manner of Death hn Natural Cause 0 Accident 0 Homicide El Suicide 0 Undetermined 0 Pending
Lti Circumstances Investigation
La Medical Certifier Name Title
O Richard McKeever M.D.
Address
102 Race Track Road, Ticonderoga, NY 12883
Death Certificate Filed Town of District Number Register Number
City, Town or Village Ticonderoga 1 564 30
El Burial Date Cemetery or Crematory
Address
❑Entombment 06/22/2016 Pine View Crematory
®Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
`� and/or
Address
ht Hold
0 Date Point of
Di El Transportation Shipment
E 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, NY 12883
Name of Funeral Firm Making Disposition or to Whom
▪ Remains are Shipped, If Other than Above
• Address
lu
` Permission is hereby granted to dispose of the human re ins described above as indicated.
Date Issued 6/2 2/2 01 6 Registrar of Vital Statistics 11) , a_-U _�,
(signature)
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:
w• Date of Disposition G Inig Place of Disposition gµ 1--1 7e/1. ci--
a (address)
ILI
CC (section) INI
(lot number)",1 (grave number)
CI Name of Sexton or Person in Charge of Premises s�rc�
( lease priin��t))�
Signature Q Title efte�(
(over)
DOH-1555 (02/2004)