McGowan Jr., David .
NEW YORK STATE DEPARTMENT°F il, %
Streetteranof AddressUS'OneidaALrLast
dlit eaFitohrccaeres'ECF 217
Vital Records Section Burial - Transit Permit
4 Name First
Sex
, 7 David Arnold McGowan Jr. Male
:77 Date of Death Age
11/26/2018 58 Years War or Dates
Place of Death Hospital, Institution or
uj- City, Town or Village Oneida
Q Manner of Death lAilvi Natural Cause 0 Accident El Homicide 0 Suicide El Undetermined n Pending
in Circumstances 'Investigation
•0
Medical Certifier Name Title
()trona Reid MD
Address
,1,14
323 Genesee St,Oneida,New York 13421
Death Certificate Filed District Number Register Number
City, Town or Village Oneida 2601 173
-'El Burial Date Cemetery or Crematory
11/3012018 Pine View Crematorium
0 Entombment
Address
:47 IX]Cremation Queensbury Town, New York
Date Place Removed
X rn Removal and/or Held
0 Li
r!if and/or Address
7iii Hold
01
0 Date Point of
r---1
co L..j Transportation Shipment
5 by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address111—I
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Stpo Box 67,Hudson Falls,New York 12839
.-"-- Name of Funeral Firm Making Disposition or to Whom
- Remains are Shipped, If Other than Above
N Address
tr
W.
Ai
Permission is hereby granted to dispose of the human remains described above as Indicated.
•T:it
2 Date Issued 11130/2018 Registrar of Vital Statistics Susan Pufrerenti(Eactiviikal)'Signed)
71,1 (signature)
District Number 2601 Place Oneida, New York
,-
'----, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i
III Date of Disposition ja---54-1r Place of Disposition im_, V;cm) 6 ce }4,1q lot'y
(address)
iLi
64)
i (section) (lot number) (grave number)
-21.. Name of Sexton or Person in Charge of Premises -3- .1/4/2-4 S?ry tits
Z please print)
W •
-- Signature "??-7' 1
Title C__d•reiMq40 I
(over)
DOH-1555(02/2004)