McDonald Jr., Stanley NEW YORK STATE DEPARTMENT OF HEALTH 5D
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Stanley Lyle McDonald Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
_ September 11, 2018 50 War or Dates
2 Place of Death Hospital, Institution or
W City,Town,or Village Whitehall Street Address Home Oq (-06,5-7 S`Tj2�
G Manner of Death El Natural Cause C Accident ❑Homicide (Suicide ❑ Undetermined n Pending
W Circumstances Investigation
U Medical Certifier Name Title
lU Wesley Perry Coroner
Q Address
26 Mettowee St, Granville Ny 12832
Death Certificate Filed District Number Register Number 42
City,Town or Village Whitehall 1 a
❑ Burial Date Cemetery or Crematory
September 17, 2018
❑ Entombment Address
n Cremation ,
Date Place Removed
0 n Removal and/or Held
- and/or Address
F Hold
YI Date Point of
0 n Transportation Shipment
d by Common Destination
0 Carrier
- Date Cemetery Address
0 ❑ Disinterment
❑ 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
I-
Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped, If Other than Above
W Address
O.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued "°'1iiioit Registrar of Vital Statistics a. /) 12
Q� (signature)
District Number 51!Ai Place Whitehall,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 09/17/2018 Place of Disposition eu0,,,, te„st,-v
2 (address)
W
0
O t (section) (lot numr) (grave number)
Name of Sexton or Person in Charge of Premises $tutj/ S i'm
W (please pnnt)1
Signature Title ( NA-
(over)
DOH-1555 (02/2004)
McDonald
1...F)
Owner
Vergil McDonald
Address Plot
244 Broadway Whitehall, NY 12887 Horicon
Phone # Lot #
518-742-0000 16F
Deed # Date
4277 7/12/2021
Cost Foundation Y - N
$750.00
Location WEST-Ogden
EAST-Brownell
South-Wilson
North-Vacant
Remarks
I ACKNOWLEDGE THE RECEIPT/OF THE RULES AND REGULATIONS OF THE
PINE VIEW CEM T, o /Y: /
SIGNATURE: �,� DATE:
SIGNATURE: DATE:
Record of Interments
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MCDONALD �� l
NAME Stanley McDonald '` Age: 50
Lot Owner: vergil McDonald
Lot# Horicon 16F Grave# 1
Case: Urn
Died:9.1 1 .2 01 8 Interred:9.1 0.2 0 21
Funeral Home: Jillson FH
Cemetery: Pine View