Hunt, Edward -#---x., 7
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section t. , Burial - Transit Permit
Name First Middle Last Sex
Edward F. Hunt Male
Date of Death Age If Veteran of U.S. Armed Forces,
06/29/2014 74 yrs. War or Dates 1958-1978
}� Place of Death Town of Hospital, Institution or
Super 8 Motel
City, Town or Village Ticonderoga Street Address 1 144 Wicker Street .
O Manner of Death Natural Cause 0 Accident 0 Homicide 0 Suicide 0 Undetermined 0 Pending
WW Circumstances Investigation
Medical Certifier Name Title
d C. Francis Varga M.D.
Address
P.O. Box 768, Lake Placid, NY 12946
Death Certificate Filed Town of District Number Register Number
City, Town or Village Ticonderoga 1564 31
;` <0Burial Date Cemetery or Crematory
QEntombment 06/30/2014 Pine View Crematory
Address
®Cremation Queensbury, New York
Date Place Removed
Z❑Removal and/or Held
2 and/or Address
H Hold
61
O Date Point of
N0 Transportation Shipment
d by Common Destination
iiH Carrier
0 Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Wilcox & Regan funeral home 01 821
>i Address
11 Algonkin St. , Ticonderoga, NY 12883
i Name of Funeral Firm Making Disposition or to Whom
I Remains are Shipped, If Other than Above
'g Address
Z.
tU
L Permission is hereby granted to dispose of the human rema' de cribed e as icated.
Date Issued 6/30/201 4 Registrar of Vital Statistics1J9
I% ( gn re)
District Number 1 564 Place Town of Ti nderoga
»' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1 .
la Date of Disposition -7-Z-M Place of Disposition ,,,us
(address)
li!
()
CC (section) /,�� (lot numb (grave number)
OZ Name of Sexton or Person ' Charge of P emises L�r`r -
(please print)
u! Signature Title COraletiat
(over)
DOH-1555 (02/2004)