McDonough, Robert Albert NEWYORK STATE DEPARTMENT OF HEALTH BUrlal - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Robert Albert McDonough Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/24/2020 84 Years War or Dates 1950-1955
Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
p Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
VCircumstances Investigation
Q Medical Certifier Name Title
Rick Teetz MD
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 187
Burial Date Cemetery,Crematory or Facility Name
03/25/2020 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town,New York
Donation
0 ❑Removal Date Place Removed
and/or and/or Held
~ Hold Address
Vl
O
Date Point of
—7
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 Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
I!— Remains are Shipped,If Other than Above
Address
c
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/25/2020 Registrar of Vital Statistics ,7nlrn PaulFran--�(Ek tronicalySyned)
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z Date of Disposition 3'26-20 Ze) Place of Disposition �l[�"'n
W
2 (address)
W
to
(section) ) (lotnumber) (grave number)
GName of Sexton or P in rge of Premises ��/ �r2 C�.• 4e-,4 Q
Z (please print)W Signature Title C%Q✓+'t 441.)-I U Pei 711 /
DOH-15551o7/t8 1of2
I'
Public Health Law Sec. 4145(2b) 013471
Receipt
Human remains of ' �A ' V' '' ''� ' ''delivered on ,. , 20.
. r-
Pine View Cemetery RepreseAting the funeral home named on burial permit
Official Funeral Directors Reg.or License# /