Donahue, Virginia f fi (13g
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Virginia Margaret Donahue Female
Date of Death Age If Veteran of U.S. Armed Forces,
07/01 /2014 84 yrs. War or Dates No
Place of Death Town of Hospital, Institution or
ill• City, Town or Village Ticonderoga Street Address 21 2 Alexandria Avenue
O Manner of Death E Natural Cause ❑Accident ElHomicide ❑Suicide ❑Undetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
41 Joseph C. Mihindu M.D.
Address
20 Murray Street, Glens Falls, NY 12801
• Death Certificate Filed Town of District Number Register Number
City, Town or Village Ticonderoga 1 564 33
El Burial Date Cemetery or Crematory
❑Entombment 2014 Pine View Crematory
Address
13Cremation Queensbury, New York
Date Place Removed
Z n Removal and/or Held
2 and/or
Address
co
Hold
0 Date Point of
it
❑Transportation Shipment
0 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
1 Remains are Shipped, If Other than Above
2 Address
ce
Permission is hereby granted to dispose of the human remai a cribed a e as- icated.
Date Issued0 7/0 3/201 4 Registrar of Vital Statistics ,t,
(sin ure)
1564 Town of Ticond ga f
District Number Place
::' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z
i<f Date of Disposition 7 l*-A i Place of Disposition ige,,) �r"..13 ..
2 (address)
Cl)LEI
(" (section) (lot number) (grave number)
0
G Name of Sexton or Person i Char of Premises Cr, St„A
Z (please print)
i Signature Title624,'"Oe
(over)
DOH-1555 (02/2004)