Bessette, Mary NEW YORK STATE DEPARTMENT OF HEAL sH . 4 4 ' ' 60 I
Vital Records Section Burial - Transit ' ermit
Name First Middle Last Sex
Mary L _ Bessette Female
: Date of Death Age If Veteran of U.S. Armed Forces,
September 11 , 201 2 80 yrs. War or Dates No
IH Place of Death Town of Hospital, Institution or Heritage Commons
WCity, Town or Village Ticonderoga Street Address Residential Healthcare
a Manner of Death Natural Cause ❑Accident ❑Homicide 0 Suicide ri❑Undetermined ri❑Pending
I Circumstances Investigation
al Medical Certifier Name/' Title
n 6LeAl Cb it,, #nM41 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 `J 3
❑Burial Date Cemetery or Crematory
09/13/2012 Pine View Crematory
❑Entombment Address
DCremation Queensbury, New York
Date Place Removed
Removal and/or Held
and/or Address
0
F;;
Hold
0 Date Point of
Transportation Shipment
Gs 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, New York 12883
iEp Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
i
Ill
"7: Permission is hereby granted to dispose of the human remains cribed ab as i d ated.
Date Issued 9/1 3/201 2 Registrar of Vital Statistics2Z2U/27e,
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:
ill Date of Disposition q-('it Place of Disposition ,,, a.") (,r,larit ..
(address)
Ui
Ir (section) " (lot num ) (grave number)
Name of Sexton or Person in Char of Premises gi+Jt ,
6Et (please print)
Signature "T- Title CI Ml ak
(over)
DOH-1555 (02/2004)