McGough, Anna NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle L�St Sex
Anna McGough Female
Date of Death Age If Veteran of U.S. Armed Forces,
10/05/2013 0 years War or Dates
by Place of Death Hospital, Institution or
3 City, TAW(Vi11Xcla Glens Falls Street Address Glens Falls Hospital
Manner of Death❑Natural Cause 0 Accident 0 Homicide 0 Suicide 0 Undetermined ri Pending
Ut Circumstances Investigation
W Medical Certifier Name Title
O Anne Soucy M D
Aii6eeouth St Glens Falls, N Y
Death Certificate Filed District Number Register Number
City, TAM&VOW Glens Falls 5601 7
❑Burial Date !� Cemetery or Crematory
38120/230 15 , P�''e VIo n Oe ete v
QEntombment Address
❑Cremation Queensbury, NY 12804
Date Place Removed
Z ri Removal and/or Held
2 and/or Address
Hold
0 Date Point of
d' Ei Transportation Shipment
5 by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
>< Address
402 Maple Street Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
i
ill
Permission is hereby granted to dispose of the human remains desccr ed a ove indi to .
Date Issued 11/04/2013 Registrar of Vital Statistics /:v'
(signature)
District Number 5601 Place Glens Falls
1 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
ut Date of Disposition 8/20/1 5 Place of Disposition Pine View Cemetery, Queensbury, NY
2 (address)
W tO New Kenesaw 1A Mausoleum
CC (section) (lot number) (grave number)
CI Name of S= •'i n or Person in Charge of Premises Connie L. Goedert
z (please print)
S.44 `�. r�Gt�N4
ignatur Title Cemetery Superintendent
(over)
DOH-1555 (02/2004)