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Gallagher, John Phillip NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John Phillip Gallagher Male Date of Death Age If Veteran of U.S.Armed Forces, 10/07/2020 65 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital • Manner of Death ©Natural Cause Accident El Homicide EiSuicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title G Brittany Tayler MD Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 2147 Burial Date Cemetery,Crematory or Facility Name 10/08/2020 Pine View Crematorium EiEntombment Address Cremation Queensbury Hamlet,New York ElDonation Z ❑Removal Date Place Removed - and/or and/or Held - Hold Address tN 0 O. Date Point of N Li Transportation Shipment a by Common Carrier Destination IDDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom � . Remains are Shipped,If Other than Above 2 Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/08/2020 Registrar of Vital Statistics 'Dante(e S Gi (ffectronicaQy Signed) (signature/ District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z ``�� Date of Disposition f t)�q�ZO Place of Disposition 'f�nyVt�-- �'�--- 2 (address) W CC (section/ (lot num (grave number) SName of Sexton or Person in Charge of Premise ()Reese print) Z / W Signature r Title ` "� � DOH-1555(018)p t of 2 1 Public Health Law Sec. 4145(2b) 01 4 0 90 Receipt Human remains of '� delivered on , 20 Pine View Cemetery Representing the funeral home named n burial permit Official Funeral Directors Reg.or License#. • '