Loading...
Usher, Daniel Edward NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Daniel Edward Usher Male Date of Death Age If Veteran of U.S.Armed Forces, 12/02/2021 59 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Ticonderoga Town Street Address Elderwood at Ticonderoga W Manner of Death W1=1 1:11=1Undetermined Pending© Natural Cause Accident Homicide Suicide Circumstances Investigation W Medical Certifier Name Title CI Nicholas Montello NP Address 1019 Wicker St,Ticonderoga Town,New York 12883 Death Certificate Filed District Number Register Number City,Town or Village Ticonderoga 1564 64 ❑Burial Date Cemetery,Crematory or Facility Name 12/03/2021 Pine View Crematorium ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation o ElRemoval Date Place Removed and/or and/or Held HN Hold Address O Date Point of t/) 11 Transportation CI by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address Q W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/03/2021 Registrar of Vital Statistics Tonya M Thompson(ECectronicaCCy Signed) (signature) District Number 1564 Place Ticonderoga, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Zf L Date of Disposition 1 Z 11 It Place of Disposition (address) W N (section) (lot number) (grave number) S Name of Sexton or Person in Charge Premises r,s ywwf;lf (pl se print) W Signature Gf _ Title `fuU ��Vt, DOH-1555(07/18)p 1 of 2 1 .__ • Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20y/ Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#