Palandrani, Robert II S-36-
NEW YORK STATE DEPARTMENT OF HEALTH '''`Ii A
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert Joseph Palandrani Male
Date of Death Age If Veteran of U.S. Armed Forces,
07/14/2015 76 yrs. War or Dates No
14 Place of Death of Hospital, Institution or
T
City, Town or Village Town icondcr Street Address 732 N.Y. State Rte. 9N
Iliilk Manner of Death !! Natural Cause Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
to Circumstances Investigation
at Medical Certifier Name Title
Peter Sayers M.D.
Address
Miller Drive, Crown Point, New York 12928
Death Certificate Filed Town of District Number Register Number
City, Town or Village Ti mndprnga 1 C64 40
is❑Burial Date Cemetery or Crematory
Address
❑Entombment 07/20/2015 Pine:'View"Crematory
®Cremation Queensbury, New York
Date Place Removed
Z ❑Removal and/or Held
2 and/or Address
1.;;
U)
Hold
Date Point of
i❑Transportation Shipment
0 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 01821
Address
11 Algonkin St., Ticonderoga, NY 12883
II Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
' Address
la
f` Permission is hereby granted to dispose of the human rem ins described above as indicated.
Date Issued 07/16/2015 Registrar of Vital Statistics 0n
(signature)
li District Number 1564 Place Town of Ticonderoga
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ILI Date of Disposition 1 1 Oil Place of Disposition 1Z4 .,,,,
(.r4/COr--'
(address)
ILI
CO
CC (section) A (let numb (grave number)
Name of Sexton or Person in Ch rge of Premises 21v4...
please print)
Ili:: Signature Title (l2''���
(over)
DOH-1555 (02/2004)