Conlon, Frank fra0
NEW YORK STATE DEPARTMENT OF HEAI`_T1i *
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Frank J. Conlon Male
Aii Date of Death Age If Veteran of U.S. Armed Forces,
10/10/2013 92 yrs. War or Dates Korean War
Place of Death Town of Hospital, Institution or
ii City, Town or Village Ticonderoga Street Address 36 The Portage
a Manner of Death® Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
tii Circumstances Investigation
at Medical Certifier Name Title
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 1 664
❑Burial Date Cemetery or Crematory
R;ii❑Entombment 1 0/1Address1 /201 3 Pine View Crematory
®Cremation Queensbury, New York
Date Place Removed
0❑Removal and/or Held
and/or
i, Address
co
0 Date Point of
ti❑Transportation Shipment
a by Common Destination
mi Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
<> Name of Funeral Home Wilcox & Regan fnneral home 01 871
Miii Address
11 Algonkin St _ Tionderoga, NY 12883
Name of Funeral Firm MaICi c
ng Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Z
In
it
Permission is hereby granted to dispose of the human rem ' scribed a -j ated.
Date Issued 1 0/1 1 /2 01 3 Registrar of Vital Statistics o
(sig - e)
illi 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:
I� Date of Disposition 61 It 113 Place of Disposition 4 w. ,`
(address)
ILI
fa
S (section) (lot number)l` (grave number)
14 Name of Sexton or Person ' Charge f Premises -�t'"- "
Z lease print)
9
iti
Si nature A . Title _ e YC-
(over)
DOH-1555 (02/2004)