Duell, Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH it 71
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Elizabeth Agnes Duell Female
Date of Death Age If Veteran of U.S. Armed Forces,
10/24/2015 99 yrs. War or Dates No
Place of Death Town of Hospital, Institution or Heritage Commons
ii City, Town or Village Ticonderoga Street Address Residential Health Care
Manner of Death LLI1771 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
fa Circumstances Investigation
ill Medical Certifier Name Title
43 Richard McKeever M.D.
Address
1019 Wicker Street, Ticonderoga, New York 12883
iliii Death Certificate Filed Town of District Number Register Number
City, Town or Village Ticonderoga 1 564 59
gii ❑Burial Date Cemetery or Crematory
10/27/2015 Pine View Crematory
['Entombment Address
`;'Cremation Queensbury, New York
Date Place Removed
Removal and/or Held
2 and/or Address
t= Hold
{O Date Point of
11 A Transportation Shipment
a by Common Destination
iffi Carrier
Q Disinterment Date Cemetery Address
a ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Wilcox & Regan funeral home 01 821
ui
Ms Address
11 Algonkin St. , Ticonderoga, New York 12883
Name of Funeral Firm Making Disposition or to Whom
14 Remains are Shipped, If Other than Above
', Address
tr
4U
Permission is hereby granted to dispose of the human re sins described above as indicated.
iliii Date Issued1 0/2 7/201 5 Registrar of Vital Statistics ` /7 , CCii-e- -.
(signature)
iiiip District Number 1 564 Place Town of Ticonderoga
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
LEI Date of Disposition tati Place of Disposition £tJ_'til0I s fis (address)
61.
Ce (section) /i/ (lot number) (grave number)
ta Name of Sexton or Person in Charge of Premises (A(oh'l�-.. Stir
..2 �` / J (please print)
Signature G��t J�•�- Title AP4
(over)
DOH-1555 (02/2004)