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McGinnis, Ronald NEW YORK STATE DEPARTMENT OF HEALTH - -gLj Vital Records Section 4 .� Burial - Transit Permit Name First Middle Last Sex Ronald L McGinnis Male Date of Death Age If Veteran of U.S.Armed Forces, i, September 24, 2018 74 War or Dates Z Place of Death Hospital, Institution or W City,Town, or Village Whitehall Street Address Home a Manner of Death n Natural Cause n Accident ❑ Homicide nSuicide n Undetermined ❑ Pending W Circumstances Investigation U Medical Certifier Name Title W Michael Lees MD MD Q Address West Street Rutland Vermont Death Certificate Filed District Number Register Number City,Town or Village Whitehall 5-tag' 7 n Burial Date Cemetery or Crematory September 28, 2018 Pineview Crematorium 1-1 Entombment Address n Cremation 21 Quaker Road Queensbury, NY 12804 Date Place Removed 0 El Removal and/or Held - and/or Address I' Hold 0 Date Point of 0 n Transportation Shipment C. by Common Destination 0 Carrier - Date Cemetery Address 0 ❑ Disinterment n Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Jillson Funeral Home, Inc. 00885 Address 46 Williams Street, Whitehall, New York 12887 kName of Funeral Firm Making Disposition or to Whom ix Remains are Shipped, If Other than Above W Address O. Permission is hereby granted to dispose of the human ains described above as indicated. Date Issued 5--a-I-d© ? Registrar of Vital Statistics G. (signature) District Number S`ia 8 Place Whitehall,New York F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition 09/28/2018 Place of Disposition Pineview Crematorium 2 (address) III 13 0 (section) (Iqt number) (grave number) Name of Sexton or Person in Charge of Premise 1 IA iiii Z (pleie print) W 4 Signature .� Title 6 9pa (over) DOH-1555 (02/2004) AI