Crannell, Karl NEW YORK STATE DEPARTMENT OF HEALTF4 : # 7$
Vital Records Section Burial -Transit Permit
Name First Middle Last Sex
Karl Lewis Crannell Male
Date of Death Age If Veteran of U.S. Armed Forces,
1 0/2 8/2 01 5 61 yrs. War or Dates No
Place of Death Town of Hospital, Institution or
City, Town or Village Ticonderoga Street Address 40 Amherst Avenue
1,k1Manner of Death 0 Natural Cause Accident Homicide Suicide Undetermined Pending
to Circumstances Investigation
W Medical Certifier Name Title
O. Glen Chapman M.D.
iiM Address
P.O. Box 29, Ticonderoga, New York 12883
Death Certificate Filed Town of District Number Register Number
Nil City, Town or Village Ticonderoga 1 564
❑Burial Date Cemetery or Crematory
10/30/2015 - Pine View Crematory
['Entombment Address
[�Cremation
Queensbury, New York
Date Place Removed
2❑Removal and/or Held
1 and/or Address
t Hold
O Date Point of
Transportation Shipment
5 by Common Destination
Carrier
❑Disinterment Date Cemetery Address
:aii
Reinterment Date Cemetery Address
;g Permit Issued to Registration Number
Name of Funeral Home Wilcox & Regan Funeral Home 01 821
Mihl 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
Cr
ftf
` Permission is hereby granted to dispose of the human rem ' s descri abo as indicated.
gi Date Issued 1 0/2 9/2 01 5 Registrar of Vital Statistics 'WIN .-
signature)
District Number 1 564 Place Town of Tico ero
>;, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
fLI Date of Disposition /013011c Place of Disposition Ri(L ( ►--tcr.'
(address)
ILI
CC (section) 1 (lot number) (grave number)
ti Name of Sexton or Person in Char a of Premises L^'�1 simAti#-
(please print)
10 eimfa
Signature 4 Title
(over)
DOH-1555 (02/2004)