Reardon, Nilda / SS"
NEW YORK STATE DEPARTMENT OF HEALTH 'I Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Nilda Reardon Female
`> Date of Death Age If Veteran of U.S. Armed Forces,
3/17/2013 74 yrs. War or Dates No
Place of Death Town of Hospital, Institution or
laCity, Town or Village Ticonderoga Street Address Moses-Ludington Hospital
a Manner of Death Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
tit Circumstances Investigation
la Medical Certifier Name Title
O Todd R. Waldorf D.O.
Address
1019 Wicker Street, Ticonderoga, NY 12883
Death Certificate Filed Town of District Number Register Number
City, Town or Village Ticonderoga 1 564 21
❑Burial Date Cemetery or Crematory
Li Entombment 3/20/201 3 Pine View Crematory
Address
;Cremation Queenchury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
t: Hold
t/3
O Date Point of
Transportation Shipment
a 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
Remains are Shipped, If Other than Above
;; Address
CC
CL
Permission is hereby granted to dispose of the human rem ins described above as indicated.
Date Issued 3/2 0/2 01 3 Registrar of Vital Statistics
(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:
• Date of.Disposition Place of Disposition IVJ Z 'ft Cvuu) Egg-iv)✓44-6
(address)
W
CC (section) , (lot number) (grave number)
Name of Sexton Pe son arge of Premises �� w \✓lv) 1
(please print)
• Signature Title 0-C44141 le 43 T
(over)
DOH-1555 (02/2004)