Shedd, Linda J /I
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Linda J Shedd Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/03/2023 81 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Ticonderoga Town Street Address Elderwood at Ticonderoga
p Manner of Death ❑X Natural Cause Accident Homicide Suicide ❑Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
o Nathalie Abisror MD
Address
1019 Wicker St,Ticonderoga Town,New York 12883
Death Certificate Filed Town Of Ticonderoga District Number Register Number
City,Town or Village 1564 2
Burial Date Cemetery,Crematory or Facility Name
01/06/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York ,
Donation
0 Removal Date Place Removed
and/or and/or Held
pN Hold Address
0
a Date Point of
Cl)❑Transportation Shipment
5 by Common
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
i.- Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/05/2023 Registrar of Vital Statistics Tonya IM Thompson(ECectronica((ySigned)
(signature)
District Number 1564 Place Town Of Ticonderoga
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z �—�
W Date of Disposition I �9 �T3 Place of Disposition ` I ��U
2 (address)
W U)
CC (section) 4 !(/otnumber) �,-• ,A (grave number)
Name of Sexton or Person in Charge of . mises a 1
Z Tease print)
W Signature Title (if_4/t�
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0 ,
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#