Abbott, Gerald NEW YORK STATE DEPARTMENT OF HEALTH i SS Z
Vital Records Section h _ 4 . Burial - Transit Permit
ffi Name First Middle Last Sex
Gerald Elbridge Abbott Male
Date of Death Age If Veteran of U.S. Armed Forces,
Ri July 23, 2016 94 yrs. War or Dates 1940-1945
i4 Place of Death Town of Hospital, Institution or Heritage Commons
City, Town or Village Ticonderoga Street Address Residential Health Care
a Manner of Death E9 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑ Undetermined ❑Pending
Ilia Circumstances Investigation
la Medical Certifier Name Title
Richard McKeever M.D.
Address
102 Race Track Road, Ticonderoga, New York 12883
Death Certificate Filed Town of District Number Register Number
iiiiig City, Town or Village Ticonderoga 1 564 35
❑Burial Date Cemetery or Crematory
['Entombment Address
Pine View Crematory
Address
®Cremation Oueensbury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
of Hold
CD
Date Point of
iZ Ill Tr0 ansportation Shipment
C3 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, New York 12883
iilig Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
tr
UI
.` Permission is hereby granted to dispose of the human remain cribed ab as• icated.
Date Issued 7/2 6/2 01 6 Registrar of Vital Statistics JZt,
iiiii (sig at re)
aiii 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:
/ eU
t� Date of Disposition $ y(j6 Place of Disposition ��
(address)
ILI
tO
LC (section) / (lot number)(( (grave number)
Name of Sexton or Person in Charge of Premises /Art L jlvi. -
z ( lease print)
ta Signature Title Cli 1 .
(over)
DOH-1555 (02/2004)