Nadeau, Meghan 1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Meghan Amber Nadeau Female
Date of Death Age If Veteran of U.S. Armed Forces,
12/31 /2014 30 yrs. War or Dates No
Place of Death Hospital, Institution or
Town of
WCity, Town or Village Ticondcr a Street Address 51 The Portage
a Manner of Death®Natural Cause u Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
u Medical Certifier Name Title
Glen Chapman M.D.
Address
P.O. Box 29, Ticonderoga, New York
Death Certificate Filed Town of District Number Register Number
City, Town or Village Ti --nderoga 1 564
❑Burial Date Cemetery or Crematory
['Entombment1 /02/201 5 Pine View Crematory
Address
Cremation Oueensbury, New York
Date Place Removed
Z❑Removal and/or Held
2 and/or Address
H Hold
CA
0 Date Point of
11` Transportation Shipment
Q by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑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
Remains are Shipped, If Other than Above
Address
ILI
P` Permission is hereby granted to dispose of the human rem ' d//e�scribedd/ o e as i 'cated.
Date Issued 1 /2/201 5 Registrar of Vital Statistics � G��'" r
(sig to )
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:
til Date of Disposition 1 /r,jIS Place of Disposition 410, Cril,-(4xJ.•,..
(address)
W
CA
CC (section) II pot numbe (grave number)
Name of Sexton or Person in Charge of Premises hoitt*i 3ut
(p/ ase print)
ill
iiiiiii Signature iti- Title (a AT2
(over)
DOH-1555 (02/2004)