Halm, Joseph -t NEW YORK STATE DEPARTMENT OF HEALTH (il
Vital Records Section Burial - Transit Pent it
Name First Middle Last Sex
Joseph Arthur Halm Male
Date of Death Age If Veteran of U.S. Armed Forces,
7/2 7/2 01 4 51 yrs. War or Dates No
1- Place of Death Town of Hospital, Institution or
WCity, Town or Village Ticonderoga Street Address Moses-Ludington Hospital
W Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide 0 Undetermined ❑Pending
Circumstances Investigation
t Medical Certifier Name Title
0 C. Francis Varga M.D.
Address
P.O. Box 768, Lake Placid, NY 12946
Death Certificate Filed Town of District Number RegisteiNumber
City, Town or Village Ticonderoga 1 564 37
❑Burial Date Cemetery or Crematory
['Entombment Address
Pine View Crematory
Address
®Cremation Queensbury, New York
Date Place Removed
Z ❑Removal and/or Held
2 and/or Address
Cl)
old
CA
O Date Point of
td Transportation Shipment
C 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
2 Address
Cr
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2. Permission is hereby granted to dispose of the human rema' scribed ab as ' •'cated.
Date Issued 0 7/29/201 4 Registrar of Vital Statistics / tit,
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District Number 1 564 Place Town of Ticon oga
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Liu• Date of Disposition,o f 1 / Place of Disposition rv,e >c_,/ 0-2.--4,718'?v X-..-.
(address)
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/ (section) of n-tuber) d (grave number)
p Name of Sexton o n . rge of Premises
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W Signature O./ Title lts1�? x / S�
(over)
DOH-1555 (02/2004)