Macnab, Alan L
NEW YORK STATE DEPARTMENT OF F-ALTH
Vital Records Section ' 0.44, Burial - Transit Permit
Name First Middle Last Sex
ALAN D. ' ACNAB Male
ni Date of Death Age If Veteran of U.S. Armed Forces,
02/18/06 71 War or Dates Korea
Place of Death Hospital, Institution or
i , Town et-Village Harrietstown Street AddresAdrr Medical Center
ILI
Manner of Death Natural Cause ❑Accident 0 Homicide ❑Suicide ❑ Undetermined ❑Pending
iii Circumstances Investigation
ill Medical Certifier Name Title
0 David A_ Johnson, MD
Address
4-ir'c M_dic�i enter,. Sar nac ia'ce, NY
Death Certificate Filed District Number Register Number
giiii Lify, Town er- e Harrietstown 1663
i!!:ii1=1Burial Date Cemetery or Crematory
DEntombment 02/21/06 Fine Vie; Crematory
Address
i ❑Cremation Queensbury, NY
Date Place Removed
❑
Removal and/or Held
and/or Address f;;
CA
Hold
0 Date Point of
CL ❑
t Transportation Shipment
0 by Common Destination
Mii Carrier
El Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
iEiiii Permit Issued to Registration Number
Name of Funeral Home '`7 B C l a r'c, Inc. 01146
Address
2310 Saranac Ave. , Lace Placid, NY 12946
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
tr.
LEI
Permission is hereby granted to dispose of the human ains described above s indicated.
Date Issued 0 2/2 0/0 6 Registrar of Vital Statistics � ,
(signature)
District Number 1663 Place7L,„Li_c_ A ) ,67.
I certify that the remains of the decedent identified above were disposed in accordance with this permit on:
2P ) - 3d Dispositionf� p1i'J Cf EM14+d‘Z1`t)III Date of Disposition ,,� (�Place of �
(address)
LEE
U,
CC (section) (lot
nu mb rg) (grave number)
Name of Sexton or Person in Charge of Premises a '�/ �.�
(please print)
Signature6a,ctir, Title C P Li 44 0 r?.
(over)
DOH-1555 (02/2004)