Wright, Winifred NEW YORK STATE DEPARTMENT OF HEALTH
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Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Winifred Thorpe Wright Female
0 ate of
9ea 1 5 Aq If Veteran of U.S. Armed Forces,
War or Dates
Place of Death Town of Hospital, Institution or
Z City, Town or Village Ticonderoga Street Address 7 Holcomb Avenue
aManner of Death n..9 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
ili
Ca
Circumstances Investigation
111 Medical Certifier Name Title
0 Glen Chapman M.D.
Address
P.O. Box 29, Ticonderoga, NY 12883
Death Certificate Filed Town of District Number Register Number
City, Town or Village Ticonderoga 1 564 33
❑Burial Date Cemetery or Crematory •
05/29/2015 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York
Date Place Removed
F.
❑Removal and/or Held
2 and/or Address
F- Hold
CO
O Date Point of
❑Transportation - Shipment
0 by Common Destination
Carrier _
'<' ❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
>= Permit Issued to Registration Number
<l Name of Funeral Home Wilcox & Regan funeral home 01 821
", Address
F11 Algonkin St. , Ticonderoga, NY 12883
Name of Funeral Firm Making Disposition or to Whom
- Remains are Shipped, If Other than Above
;'; Address
I
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Permission is hereby granted to dispose of the human rema" s escribed a as i " ated.
`.i Date Issued 5/29/201 5 Registrar of Vital Statistics � at '\SU ((YN,,
(signature)
District Number 1 564 Place Town of Ticonder ga
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k
III Date of Disposition r./ Z I I s' Place of Disposition giJ,j C--6
in (address)
U)
CC (section) ,(ot number) (grave number)
el Name of Sexton or Person in Charge of Premises �rL .Jurit
',"! 4 (plea a print)
Signature Title !n'%'1' !l
(over)
DOH-1555 (02/2004)