Armstrong, Patrick ta." yik # qg I
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Trans t Permit
iniii Name First Middle Last Sex
Patrick Owen Armstrong Male
Date of Death Age If Veteran of U.S. Armed Forces,
II 07/01 /201 6 69 yrs. War or Dates No
.14 Place of Death Town of Hospital, Institution or Heritage Commons
City, Town or Village Ticonderoga Street Address Residential Health Care
Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
IW Circumstances Investigation
jj Medical Certifier Name Title
1 Richard McKeever M.D.
Address
102 Race Track Road, Ticonderoga, NY 12883
Riiii Death Certificate Filed Town of District Number Register Number
Uiii City, Town or Village Ticonderoga 1 564
Ei❑Burial Date Cemetery or Crematory
El Entombment 7/5/2016 Pine View Crematory
Address
®Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
— Hold
Date Point of
to Li Transportation Shipment
G! by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date ' Cemetery Address
iigPermit Issued to Registration Number
iiiia Name of Funeral Home Wilcox & Regan funeral home 01 821
Address
11 Algonkin St. , Ticonderoga, New York 12883
iiiigi Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
;; Address
Lti
CC` Permission is hereby granted to dispose of the human rema' de cribed a o e a ' •dic ted.
hi Date Issued 7/1 /2 01 6 Registrar of Vital StatisticsiljtIL- (si.„ ,-)
Mi District Number 1 564 Place Town of Ticon oga
: I certify that the remains of the decedent identified above were disposed of in accordancewith this permit on:wt---
a tip Date of Disposition 7/I. �� Place of Disposition /INOu
2 (address)
III
Ul
CC (section) A flot numbe (grave number)
el Name of Sexton or Person in Charge of Premises G h,:T 3/444.7
Z ( ease print)
Signature J ...e."ram Title M W
(over)
DOH-1555 (02/2004)