Loading...
Aitner, Mary I NEW YORK STATE DEPARTMENT OF HEALTH t ill Vital Records Section Burial - Transit Permit Name First Middle Last Sex Mary Ellen Aitner Female Date of Death Age If Veteran of U.S. Armed Forces, March 9, 2013 64 yrs. War or Dates No w . Place of Death Town of Hospital, Institution or Heritage Commons X City, Town or Village Ticonderoga Street Address Residential Healthcare ci Manner of Death®Natural Cause El Accident 0 Homicide 0 Suicide El Undetermined Ei Pending lit Circumstances Investigation tu Medical Certifier Name Title 41 Richard McKeever M.D. Address 1019 Wicker Street, Ticonderoga, NY 12883 Death Certificate Filed Town of District Number Register plumber City, Town or Village Ticonderoga 1 564 1 DBurial Date Cemetery or Crematory 3/13/2013 Pine View Crematory ❑Entombment Address ©Cremation Queensbury, New York 101 ` Date Place Removed ❑Removal and/or Held and/or to Address C Hold Date Point of to Li Transportation Shipment . by Common Destination Carrier Q 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 L 7' Permission is hereby granted to dispose of the human remains cribed abo e as in•. ated. Date Issued 3/1 2/201 3 Registrar of Vital Statistics 4-)11/ 45-''` (sign: e) District Number 1 564 Place Town of Tic deroga :I ceI certify that the remains of the decedent identified above were disposed of in accordance with this permit on; ILI V Date of Disposition �/�/3 Place of Disposition i �.. �oe..✓ aft.g.r.if-Ae/ 2 (address) iii CC (section) j (! t number) (grave number) Name of Sexton or erson •barge of Premises � ! g iti!) -11 d (please print) I Signature / Mid- Title I�� fS°it l - -., (over) DOH-1555 (02/2004)