Casabonne, Carol A. NEW YORKSTATE DEPARTMENT OF HEALTH BUriai - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Ronald C.McDonald Male
Date of Death Age If Veteran of" All!!Ed Forces,
11/27/2019 64 Years War or Dales
Place of Death Hospital,Institution or
City,Town or Village Warrensburg Town Street Address 12 Marion Avenue,Warrensburg Town, New York 12885
`p Manner of Death ®Natural Cause Accident Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
WMedical Certifier Name Title
lei Terry Comeau Coroner
Address
1400 St Route 9,Lake George Town,New York 12845
Death Certificate Filed District Number Register Number
City,Town or Village Warrensburg 5660 20
Burial Date Cemetery,Crematory or Facility Name
12/02/2019 Pine View Crematory
ElEntombment Address
Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
O
M Date Point of
N Transportation
p by Common Shipment
Carrier Destination
❑Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
F- Remains are Shipped,If Other than Above
2 Address
cc
CL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/02/2019 Registrar of Vital Statistics Donna,4 Combs(Efectronically Signer
/signature)
District Number 5660 Place Warrensburg, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F-
W' Date of Disposition i Z 3�) Place of Disposition p(I,A—
(address)
W
N /section) llo mber)� (grave number)
0 Name of Sexton or Person in Charge 7fPmises r`j it
Z (please pr/t)
11J' Signature Title
DO H-1555(o7/18)p t of 2
Public Health Law Sec. 4145(2b) 013120
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#