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Babcock, Maurice r - --* it igl NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Maurice App) ebee Babcock Male • Date of Death Age If Veteran of U.S. Armed Forces, March 9, 2015 92 yrs. . War or Dates W.W.II F-• Place of Death Town of Hospital, Institution or ZCity, Town or Village TicondPrc?g, Street Address Moses-Ludington Hospital O Manner of Death la Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending ILI Circumstances Investigation W Medical Certifier Name Title 14 Richard McKeever M.D. Address 102 Racetrack Road, Ticonderoga, NY 12883 Death Certificate Filed Town of District Number Register Number City, Town or Village Ticonderoga 1 564 ❑Burial Date Cemetery or Crematory ❑Entombment 03/12/2015 Pine View Crematory Address ©Cremation Queensbury, New York Date Place Removed Z Removal and/or Held 2 ❑and/or F; Address CO Hold O Date Point of EL t Transportation Shipment O by Common Destination Carrier Q Disinterment Date Cemetery Address Q Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Wilcox & Regan funeral home 01 821 Address 11 Algonkin St. , Ticonderoga, NY 12883 Name of Funeral Firm Making Disposition or to Whom 14. Remains are Shipped, If Other than Above • Address.. M. 4/3 P:" Permission is hereby granted to dispose of the human rem ' described ab ve as dicated. iR Date Issued 3/11 /2015 Registrar of Vital Statistics (105..t, (sig to e) i District Number 1 564 Place Town of Ticor eroga .>.::: I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ILI• Date of Disposition 31 f3ltr Place of Disposition :r,J..k., `• ter,' (address) la (11 Ili (section) lot number) (grave number) Name of Sexton or Person in Char a of Premises 4,41�(., 3Gwo * ► (ale se rrint) ILI Signature �` _ Title (174+0l (over) DOH-1555 (02/2004)