McGraw, Wayne NEW YORK STATE DEPARTMENT OF HEALTH ,. - * ' A
Vital Records Section Burial - Transit Permit
• Name First Middle Last Sex
Wayne Thomas McGraw Male
Date of Death Age If Veteran of U.S. Armed Forces,
02/01/2018 73 Years War Or Dates 1965-1971
• Place of Death Hospital, Institution or
WCity, Town or Village Glens Falls Street Address Glens Falls Hospital
1. Manner of Death 0 Natural Cause El Accident El Homicide n Suicide ii ❑Undetermined ❑Pending
Circumstances Investigation
uj Medical Certifier Name Title
La Michael Miles MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 63
❑Burial Date Cemetery or Crematory
02/02/2018 Pine View Crematory
0 Entombment Address
®Cremation Queensbury Town, New York
`, Date Place Removed
❑• Removal and/or Held
and/or Address
CO Hold
Date Point of
❑Transportation Shipment
aby Common Destination
Carrier
❑Disinterment Date Cemetery Address
,❑Reinterment Date Cemetery Address
3...
• 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
Remains are Shipped, If Other than Above
Address
E
tPermission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/02/2018 Registrar of Vital Statistics c o6ertA Curtis(E(ectronically Signed)
(signature)
District Number 5601 Place Glens Falls, New York
t,,, I certify that the remains of the decedent identified above were disposed of in accordancep with this permit on:
1 Date of Disposition 2/4 1I$ Place of Disposition tALi I,LILy.o•
+,_'._ (address)
41)
IX (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Pre ises r.,, S�^»4tt
(p/ se print)
iLt Signature Title (REM le,
(over)
DOH-1555 (02/2004)