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Paniccia, Patricia 4 Z b0 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Patricia Anne Paniccia Female Date of Death Age If Veteran of U.S. Armed Forces, 04/19/2014 72 yrs. War or Dates No t Place of Death Town of Hospital, Institution or 5 City, Town or Village Elizabethtown Street Address Essex Center 0 Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Ui Circumstances Investigation tu Medical Certifier Name Title t Rob DeMurn M_D. Address Essex Center, 81 Park St _ , Elizabethtown, NY 12932 Death Certificate Filed Town of District Number 1�5 Register Number() City, Town or Village Elizabethtown v Iiii El Burial Date Cemetery or Crematory ❑Entombment ddress 2014 Pine View Crematory !A ddrev ®Cremation Queensbury, New York Date Place Removed ....0 ❑Removal and/or Held and/or Address Mt Hold th Date Point of Transportation Shipment a by Common Destination isii Carrier gli El Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number ppiii Name of Funeral Home Wilcox & Regan funeral home 01 821 Address pia 11 Algonkin St. , Ticonderoga, NY 12883 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above a Address 2 ill Permission is hereby granted to dispose of the human re ins scribed above as indicated. Date Issued 4/2 2/201 4 Registrar of Vital Statistics L G7�� /� / (signature) District Number /S S-� ��i26�y /2 Place !b`� I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: k ILI Date of Disposition q 01)11 Place of Disposition , , j;uJ C�..efor,,,r, (address) IAI W. CC (section) (lot num ) (grave number) ci Name of Sexton or Person . Charge of Premises it:AFL- ,Spini bi- 2 i (please pant) Signature Title Lttk (over) DOH-1555 (02/2004)