Cioffi, Lynn sx0
NEW YORK STATE DEPARTMENT OF HEALTH <
Vital Records Section Burial - Transit Permit
•
Name First Middle Last Sex
Lynn Marie Cioffi Female
Date of Death Age If Veteran of U.S. Armed Forces,
September 24, 201 3 50 yrs. War or Dates No
}- Place of Death Town of Hospital, Institution or
Z City, Town or Village Ticonderoga Street Address 122 Killicut Mountain Rd.
Z Manner of Death Natural Cause Accident u Homicide Suicide Undetermined Pending
Lf i Circumstances Investigation
tu Medical Certifier Name Title
C. Francis Varga M.D.
Address
P.O. Box 768, Lake Placid, NY 12946
Death Certificate Filed Town of District Number Register Number
City, Town or Village Ticonderoga 1 5 6 4 6 6.
❑Burial Date Cemetery or Crematory
09/26/2013 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York
Date Place Removed
Z ❑Removal and/or Held
and/or
Address
Hold
lb
O Date Point of
CL 0 Transportation Shipment
CA
G3 by Common Destination
Carrier
El Disinterment Date Cemetery Address
1-1
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Wilcox & Regan Funeral Home 01 821
Address
gi 11 Algonkin St. , Ticonderoga, New York 12883
ai Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
tr
iti
g" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 0 9/2 6/201 3 Registrar of Vital Statistics a in,
• (signature)
Eii 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:
Place of Disposition R ko.) Ci.etof t4+_t� Date of Disposition 9f Z7113 P
2 (address)
Il
U,
CC (section) ( t number) (grave number)
fa Name of Sexton or Person incharge of Prem. es i,` ," '1""4
2 please print)
IIi
Signature �� Title 620
(over)
DOH-1555 (02/2004)