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Denman, Ella r , 5 � NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Ella Mae Denman Female Date of Death Age If Veteran of U.S. Armed Forces, 1 0/2 0/2 01 2 87 yrs. War or Dates No Place of Death Town of Hospital, Institution or X City, Town or Village Ticonderoga Street Address Moses-Ludington Hospital Manner of Death Natural Cause 0 Accident 0 Homicide 0 Suicide riUndetermined ri Pending W. Circumstances Investigation ut Medical Certifier Name Title Kathleen A. Pangia M.D. Address Racetrack Road, Ticonderoga, New York 12883 Death Certificate Filed Town of District Number Register9 Number City, Town or Village Ticonderoga 1 564 ><0Burial Date Cemetery or Crematory 10/23/2012 Pine View Crematory []Entombment Address ®Cremation Queensbury, New York Date Place Removed Removal and/or Held 9C El and/or Address 111 Hold fi 0 Date Point of d❑Transportation Shipment CS by Common Destination Carrier Q Disinterment Date Cemetery Address v.Q Reinterment Date Cemetery Address 'Permit Issued to Registration Number `: Name of Funeral Home Wilcox & Regan funeral home 01 821 Address 11 Algonkin St. , P.O. Box 543, Ticonderoga, NY 12883 iiii Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address al f IL Permission is hereby granted to dispose of the human remains d s - ed above s indi a ed. :: Date Issued 1 0/23/201 2 Registrar of Vital Statistics 1� ,,.,, (signatu 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: � I ' Cam' #� Date of Disposition i©-:�5-1'L Place of Disposition ;ire V(tU�� o f;4 -- (address) l CC (section) h (lot number) (grave number) et Name of Sexton or Person in Charge Premises IN ri st S"'t ( lease print) Si Title c�,��cd 6 gnature (over) OH-1555 (02/2004)