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Armstrong, Isabelle NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Isabelle J. Armstrong Female Date of Death Age If Veteran of U.S. Armed Forces, 01 /1 1 /2 01 4 61 yrs. War or Dates No 1- Place of Death Town of Hospital, Institution or Heritage Commons City, Town or Village Ticonderoga Street Address Residential Healthcare Manner of Death©Natural Cause ❑Accident ❑Homicide Suicide Undetermined ElPending Circumstances Investigation tu Medical Certifier Name Title Q Richard McKeever M.D. Address 1019 Wicker Street, Ticonderoga, NY 12883 Death Certificate Filed Town of District Number Register Number City, Town or Village Ticonderoga 1 564 05 ❑Burial Date Cemetery or Crematory 01 /14/2014 Pine View Crematory ❑Entombment Address ❑X Cremation Queensbury, New York Date Place Removed Z ❑Removal and/or Held 2 and/or Address = Hold U) 0 Date Point of ❑Transportation Shipment G 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 t P` Permission is hereby granted to dispose of the human r mains described above as indicated. Date Issued 01 /1 4/201 4 Registrar of Vital Statistics :72-) . � .. (signature) 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: ILI Date of Disposition k/Ito(f4 Place of Disposition V . r NAOINI (address) ILI CC (section) (lot number) C (grave number) Name of Sexton or Person i Charge of Premises nist61' r l — ( lease print) g Si nature )` Title Gbe]}t ae (over) DOH-1555 (02/2004)