Manning, Helen trrtg
NEW YORK STATE DEPARTMENT OF HEALTH ``".
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Helen L. Manning Female
Date of Death Age If Veteran of U.S. Armed Forces,
1 0/02/201 5 73 yrs. War or Dates No
1 Place of Death Town of - Hospital, Institution or
Z City, Town or Village Ticonderoga Street Address 60 Adirondack Drive
Uj
Manner of Death Natural Cause Accident 0 Homicide 0 Suicide 0 Undetermined Pending
lj Circumstances Investigation
ui Medical Certifier Name Title
44 C. Francis Varga M.D.
Address
P.O. Box 768, Lake Placid, New York 12946
Death Certificate Filed Town of District Number Register Number
ni City, Town or Village Ticonderoga 1 564
OBurial Date Cemetery or Crematory
10/06/2015 Pine View Crematory
gii;UEntombment Address
®Cremation Queensbury, New York
Date Place Removed
Z O Removal and/or Held
and/or Address
I= Hold
fil
0 Date Point of
0 Li Transportation Shipment
C by Common Destination
Carrier
j Q Disinterment Date Cemetery Address
m ElReinterment Date Cemetery Address
iiii Permit Issued to Registration Number
Name of Funeral Home Wilcox & Regan Funeral Home 01 821
Address
11 Algonkin St. , Ticonderoga, New York 12883
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
CC
La
" Permission is hereby granted to dispose of the human re ' s escrib bo -'a indicated.
Date Issued 1 0/0 6/201 5 Registrar of Vital Statistics • L
fnat.
ure)
District Number 1 564 Place Town of Tico eroga
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition /0/11 Ii 1 Place of Disposition . .. f!'w�...un _
2 (address)
til
>I
(section) /// (lot number (grave number)
ilk Name of Sexton or Person in Char a of Premises X 3itas
Z
( lease print)
tJ Signature 4- Title rv./4 7/
(over)
DOH-1555 (02/2004)