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McLaughlin Jr., William 73b NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial- Transit Permit Name First Middle Last Sex William Sheedy McLaughlin Jr Male • Date of Death Age If Veteran of U.S. Armed Forces, 09/06/2018 73 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation - Medical Certifier Name Title # `• Marcille Labban MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 427 ❑Burial Date Cemetery or Crematory 09/10/2018 Pine View Crematory • ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held = and/or Address g Hold Date Point of ❑Transportation Shipment • by Common Destination Carrier 4 `El Disinterment Date Cemetery Address az Li Reinterment Date Cemetery Address Permit Issued to Registration Number 4. 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 Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/10/2018 Registrar of Vital Statistics cp6ertA Curtis(E[ctronica(6 Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition tit fi iS Place of Disposition ?�U.,, lrtA.10ri.N, (address) (section) tnumber) ( (grave number) Name of Sexton or Person in Charge of Premises lift r•; �+r.*' J r 404 t M� (plea a print) Signature !.✓tom Title OVAPITD2 (over) DOH-1555 (02/2004)