McGough, Anthony NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
:i Name FirstAnthony Middle LMcGough Sex Male
Date of Death Age If Veteran of U.S. Armed Forces,
10/05/2013 0 years War or Dates
hW Place of Death Hospital, Institution or
Z City, TdW Nfr s( Glens Falls Street Address Glens Falls Hospital
Manner of Death❑Natural Cause 0 Accident El Homicide n Suicide 0 Undetermined 0 Pending
IliCircumstances Investigation
til Medical Certifier Name Title
G Anne Soucy M D
Addre s
90 south St-Glens Falls, N Y '
Death Certificate Filed District Number Register Number
City, TcV (&MFA Glens Falls 5601 6
['Burial Date Cemetery or Crematory
0800/2015 Pine View Cemetery
.:: [Entombment Address
❑Cremation Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
9t ❑and/or
Address i;;
Hold
VI
0 Date Point of
a` Transportation Shipment
p by Common Destination
Carrier
El Disinterment Date Cemetery Address
Q Date Cemetery Address
Reinterment
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Mapie Street Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
J.. Remains are Shipped, If Other than Above
Address
tr
9` Permission is hereby granted to dispose of the human remains described above in ' ated.
Date Issued 11/04/2013 Registrar of Vital StatisticsAm1
(signature
District Number 5601 Place Glens Falls
.'^ I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W. Date of Disposition 8/2 0/1 5 Place of Disposition Pine View CPmPtPry, QuPPnShury, NY
. (adddress)
ttil
fil New Kenesaw 1A Mausoleum
CC (section) (lot number) (grave number)
Name of Se nor Person in Charge of Premises
Connie L. Goedert
(please print)
r Signatur ' 414411.4 Title Cemetery Superintendent
(over)
DOH-1555 (02/2004)