Fleury, Veronica NEW YORK STATE DEPARTMENT OF HEALTH g2'
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Veronica F. Fleury Female
Date of Death Age If Veteran of U.S. Armed Forces,
iiEiiii 11 /26/2016 70 yrs. War or Dates No
14, Place of Death Town of Hospital, Institution or
W. City, Town or Village Ti rnnderoga Street Address 61 Delano Road
Manner of Death J Undetermined Pending
Natural Cause �Accident �Homicide �Suicide � �
141 Circumstances Investigation
la Medical Certifier Name Title
P. K. P. Huestis M.D.
Address
102 Race Track Road, Ticonderoga, NY 12 83
Death Certificate Filed Town of District Number Register Number
City, Town or Village Tirondprnsa 1 564 55
iin❑Burial Date Cemetery or Crematory
11 /29/2016 Pine View Crematory
❑Entombment Address
yy ®Cremation Queensbury, New York
Date Place Removed
gEl❑Removal and/or Held
and/or Address
E: Hold
Date Point of
CL El Transportation Shipment
in
a by Common Destination
Carrier
iRii
Q Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
mO
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
a Address
Ili
` Permission is hereby granted to dispose of the human re i escrib bove indicated.
inii Date Issued 1 1 /2 8/2 01 6 Registrar of Vital Statistics ri /' / , `./ —
(si nature)
iig District Number 1 564 Place Town of Tic derog
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
III• Date of Disposition /Z I i (tt, Place of Disposition �M0,ir,, r!irm,�fio€,w-
(address)
Ili
CA
IE (section) ., (lot number) (grave number)
Name of Sexton or Person in Charge of Premises fititee Stmit'
( ease print)
Signature a Title Ceili i.
(over)
DOH-1555 (02/2004)
I