Kent, Irene 1 .7V 1
NEW YORK STATE DEPARTMENT OF HEALTH -r:
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
MIrene Theresa Kent Female
Date of Death Age If Veteran of U.S.Armed Forces,
f 09/13/2018 90 Years War or Dates
� Place of Death Hospital, Institution or
City, Town or Village Plattsburgh Street Address Meadowbrook Healthcare
Manner of Death j Natural Cause 0 Accident 0 Homicide Suicide �Undetermined Pending
-f Circumstances Investigation
M Medical Certifier Name Title
David Anderson MD
Address
154 Prospect Ave,Plattsburgh,New York 12901
Death Certificate Filed District Number Register Number
City, Town or Village Plattsburgh 0901 414
Burial Date Cemetery or Crematory
09/17/2018 Pine View Crematory
-„„-=❑Entombment Address
t®Cremation Queensbury, New York
Date Place Removed
Removal and/or Held
ft and/or Address
Hold
Date Point of
Q Transportation Shipment
st by Common Destination
Carrier
Date Cemetery Address
❑Disinterment
Q Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Wilcox&Regan 01821
- l Address
11 Algonkin St,Ticonderoga,New York 12883
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/14/2018 Registrar of Vital Statistics Sylvia Cj garrotte(ECectronicaf1ysignecl)
(signature)
'' District Number Place
0901 Plattsburgh, New York
1
--
1 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ill Date of Disposition j li4 lig Place of Disposition F.S... III(address)
111
(section) 1(lot number) (grave number)
Name of Sexton or Person in Charg of Premises f 6,1=piut` eN -
(p/ se print)
4,,,, Signature4 Title AM-AWL
}RL
(over)
DOH-1555 (02/2004)