Loading...
Mclaughlin,Sean Robert NEWYORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Sean Robert McLaughlin Male Date of Death Age T- 04/11/2020f Veteran of U.S.Armed Forces, 74 Years Waror Dates 1965-1973 ZPlace of Death Hospital,Institution or pCity,Town or Village Kingsbury Town Street Address 70 Dean Road, Kingsbury Town,New York 12839 Manner of Death ©W Natural Cause Accident Homicide Suicide Ej Undetermined Pending Circumstances Investigation WW Medical Certifier Name Title Thomas Kandora MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Kingsbury Town 1 5762 11 Burial Date Cemetery,Crematory or Facility Name Entombment 04/13/2020 Pine View Crematorium Address aCremation Queensbury Town,New York Donation 0 Removal Date Place Removed and/or and/or Held N Hold Address O N ❑Transportation Date Point of by Common Shipment Carrier Destination Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67, Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above 2 Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/13/2020 Registrar of Vital Statistics CynthiaA Bardin(ECectronicaCCySigned) /signature/ , District Number 5762 Place Kingsbury Town, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F— _ Z Date of Disposition NrGT I 70 Place of Disposition WR. /address/ W Cl) (section) (iot number/ (grave number/ 8Name of Sexton or Person in Charge of remises tx � Z ( ase print/ Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) i Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#