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Hogan, Patrick NEW YORK STATE DEPARTMENT OF HEALTH 1 gill Vital Records Section Burial - Trans t Permit Name First Middle Last Sex Patrick George Hogan Male Date of Death Age If Veteran of U.S. Armed Forces, November 14, 2105 73 War or Dates No } Place of Death Town of Hospital, Institution or City, Town or Village Ticonderoga Street Address 10 Rock Street a Manner of Death®Natural Cause ❑Accident ❑Homicide El Suicide El❑Undetermined ❑Pending Circumstances Investigation in Medical Certifier Name Title MA► .y � a I [a,� 1'1/f t Addr 9 �i4 ee kE ( 1 we0,1( AvS a�225� �V � • � 99Co Death Certificate Filed Town of District Number Register Number�, City, Town or Village Ticonderoga 1 564 40 RI 0 Burial Date Cemetery or Crematory DEntombment 11 /1 7/201 5 Pine View Crematory Address :'::©Cremation Queensbury, New York Date Place Removed ❑Removal and/or Held 14 and/or Address tt Hold 0 Date Point of t1 Transportation Shipment ct 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 iM 11 Algonkin St. , Ticonderoga, New York 12883 ig Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above • Address it tu Permission is hereby granted to dispose of the human rem ' s describe oveia indicated. Date Issued 11 /1 6/2 01 5 Registrar of Vital Statistics :)'' ff�'t; (si nature) gii District Number 1 564 Place Town of Tico erog `'`" I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: � f• Date of Disposition It/(1IlT Place of Disposition At V►✓ 644414 i---- Z. (address) ICED a rr (section) - (lot number) (grave number) Name of Sexton or Person in Charge f Premises at" ���" Z � please print) 41„,„„„!, Si nature Title g /2 fliA40(14( (over) DOH-1555 (02/2004)