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Chandler, Joan NEW YORK STATE DEPARTMENT OF HEALTH # 7C( Vital Records Section Burial - Transit Permit Name First Middle Last Sex Joan Fli7abeth _Chandler Female Date of Death Age If Veteran of U.S. Armed Forces, 04/06/2014 74 yrs. War or Dates No r- Place of Death Town of Hospital, Institution or Heritage Commons Zuj City, Town or Village Ticonderoga Street Address Residential Healthcare a Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending LLt Circumstances Investigation W Medical Certifier Name Title 0 Glen Chapman M.D. Address P.O. Box 29, Ticonderoga, NY 12883 Death Certificate Filed Town of District Number Register Number City, Town or Village Ticonderoga 1 564 22 El Burial Date Cemetery or Crematory 04/14/2014 Pine View Crematory ❑Entombment Address iiip®Cremation Queensbury, New York Date Place Removed t ❑Removal and/or Held and/or ; Address r Hold C3 Date Point of CL 1-1 Transportation Shipment O 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 glilil 11 Algonkin St. , Ticonderoga, NY 12883 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 2 Address CC ILA P:` Permission is hereby granted to dispose of the human re al s described abo - as indicated. Date Issued 04/0 9/2 01 4 Registrar of Vital Statistics 4).t t •ature) Mi 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: Date of Disposition q/Ho f)(4 Place of Disposition f aOf.,..) L On 2 (address) Ili >l (section) (lot numberL. (grave number) 0 • Name of Sexton or Person i Charge of Premises /Lillie' {neiti 2 (please print) ta Signature -- �r-� Title MOO- (over) DOH-1555 (02/2004)