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Towndrow, Robert NEW YORK STATE DEPARTMENT OF HEALTH 4f li 0 Vital Records Section Burial - Transit Permit Name First • Middle Last Sex Robert Russell Towndrow Male Date of Death Age If Veteran of U.S. Armed Forces, 02/24/201 3 88 yrs. War or Dates 1 943-1 946 } Place of Death Town of Hospital, Institution or Heritage Commons City, Town or Village Ticonderoga Street Address Residential Healthcare ILI12 Manner of Death©Natural Cause ❑Accident ElHomicide ❑Suicide ❑Undetermined ❑Pending la Circumstances Investigation Lu Medical Certifier Name Title O Kathleen P. Huestis M.D. Address 1019 Wicker Street, Ticonderoga, New York 12883 Death Certificate Filed Town of District Number Register Number City, Town or Village Ticonderoga 1 564 1 6 ❑Burial Date Cemetery or Crematory DEntombment 3/1 /201 "i Pine View Crematory Address ®Cremation Queensbury, New York ' Date Place Removed Z❑Removal and/or Held Pii and/or Address i'" Hold T.E.l O Date Point of El CO Transportation Shipment C by Common Destination . Carrier ni ❑Disinterment Date Cemetery Address ❑Renterment Date Cemetery Address ia Permit Issued to RegistratiQrt Number ai Name of Funeral Home Wilcox & Regan funeral home 8 Address 11 Algonkin St. , Ticonderoga, NY 12883 ilD Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above • Address Cr ILL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 2/27/201 3 Registrar of Vital Statistics da., kJ i " / (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: Z to Date of Disposition 2-5-13 Place of Disposition e, LL Cn pt,,,,V a (address) Lu CO fir (section) 4� (lot number) C (grave number) Ct Name of Sexton or Person in Charg of Premises ( I)t, Jenoi+ z ILI / ( ease print) Signature G �- Title OUFIAWN._ (over) DOH-1555 (02/2004)