Carr, Pamela NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section . ' Burial - Transit Permit
Name First Middle Last Sex
Pamela Marie Carr Female
Date of Death Age If Veteran of U.S. Armed Forces,
iiN 09/27/2016 49 yrs. War or Dates No
}- Place of Death ` Hospital, Institution or
Town of
City114 , Town or Village T1COndPrO a Street Address 7 John St _ Apt 2
0 Manner of Deatl- Natural Cause Accident ❑Homicide ❑Suicide ❑Undetermined raPending
ill Circumstances Investigation
III Medical Certifier Name Title
C. Francis Varga , M n
Address
P.O. Box 768, Lake Placid, New York 129-4.6
Death Certificate Filed Town of District Number Register Number
City, Town or Village Ticonderoga 1 564 47
❑Burial Date Cemetery or Crematory
09/29/2016 Pine View Crematory
:;❑Entombment Address
'>®Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
It Hold
w
Date Point of
i Transportation Shipment
a by Common Destination
in Carrier
3❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
iiAii Permit Issued to Registration Number
Sii Name of Funeral Home Wilcox & Regan funeral home 01 821
Address
Iii 11 Algonkin St. , Ticonderoga, New York 12883
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
at
U
cL
Permission is hereby granted to dispose of the human remains desc ibed above as indicated.
Date Issued 09/29/2016 Registrar of Vital Statistics
( gnature
District Number 1 564 Place Town of Ticonderoga
Mi
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
til 0/31 Disposition � 1 •v am aka� 1.
Date of Disposition � Place of �M, ,�
2 (address)
w
0
it (section) // (lot number) (grave number)
Name of Sexton or Person in Charged Premises ( "f ✓ -Si i�t4}-
Z /, (p ase print)
I Signature a e Title Of'PAK
(over)
DOH-1555 (02/2004)