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Cole, Eric ilk NEW YORK STATE DEPARTMENT OF HEALTH #0 Vital Records Section Burial - Transit Permit Name First Middle Last Sex ERIC JAMES COLE MALE Date of Death Age If Veteran of U.S. Armed Forces, JULY 23, 2015 55 War or Dates 1978-1981 1.4 Place of Death Hospital, Institution or W City, Town or Village CITY OF PLATTSBURGH Street Address CVPH MEDICAL CENTER Manner of Death X❑ Natural Cause ❑Accident ❑Homicide ❑Suicide D Undetermined ❑Pending Circumstances Investigation tu Medical Certifier Name Title JOHN GRIFFIN MD Address PLATTSBURGH, NY Death Certificate Filed District Number Register Number City, Town or Village CITY OF PLATTSBURGH 901 El Burial Date Cemetery or Crematory JULY 27, 2015 PINE VIEW CREMATORY Entombment Address ©Cremation QUEENSBURY, NY Date Place Removed ❑Removal and/or Held ... and/or Address F_- Hold 0 Date Point of 11❑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 01821 Address 11 ALGONKIN STREET, TICONDEROGA, NY 12883 IG Name of Funeral Firm Making Disposition or to Whom 1-4 Remains are Shipped, If Other than Above • Address cr lI Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued JULY g4, 201, iegistrar of Vital Statistics (signature) District Number 901 Place CITY OF PLATTSBURGH I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ILI• Date of Disposition 7-..5-►5 Place of Disposition 2'rte C f r fvt (address) UI ilk 11 (section 2 - (lot number) (grave number) ci Name of Sexton or Person in Cha ge of Premises l d,ncrk7 1,,, k (please print) • Signature 4,4'4+4 Title Ctc c4 cn7 4-S5; (over) DOH-1555 (02/2004)