McCarthy Sr., Michael - -
NEW YORK STATE DEPARTMENT OF HEALTH
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Vital Records Section Buria141w ransit Permit
,
Name First Middle Last .-- Sex
Michael Patrick McCarthy Sr. Male
v gt---, Date of Death
Age If Veteran of U.S.Armed F. es,
1 11124/2018 54 Years War or Dates
Place of Death Hospital, Institution or
City' Town or Village Glens Falls Street Address Glens Falls Hospital
11.1
0 Manner of Death Natural Cause 0 Accident 0 Homicide 0 Suicide El Undetermined ri Pending
tif ll Circumstances 'Investigation
tu Medical Certifier Name Title
_ ,,
Stephen Pera77elli MD
Address
4
.,. 100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
,---,:,
47. City,Town or Village Glens Falls 5601 558
re El Burial Date Cemetery or Crematory
11/2712018 Pine View Crematorium
El Entombment Address
]Cremation Queensbury Town, New York
Date Place Removed
gEl Removal and/or Held
and/or Address
El: Hold
wri .
I-1 Date Point of
Li Transportation Shipment
0, by Common Destination
Carrier
Li i--,Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
44
'''"i Permit Issued to Registration Number
rq,
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
p 68 Main Stpo Box 67,Hudson Falls,New York 12839
Az Name of Funeral Firm Making Disposition or to Whom
tt Remains are Shipped, If Other than Above
Address
---,-
, . Permission is hereby granted to dispose of the human remains described above as indicated.
p:
Date Issued 1112612018 Registrar of Vital Statistics Itobert:4 Curtis(E&CtfOniCarry Signed)
--t-.
'57 (signature)
wk
ilt 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 /1-7-7-1k Place of Disposition p th-c VI eA,, cfcsiq-+o c y
(address)
CA
(section) (lot number) (grave number)
g. Name of Sexton or Person in Charge of Premises mc,,7 Sbii rtis
4 , (please print)
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Signatu . ....a.............
re #' Title C---Feivizvfo r
(over)
DOH-1555(02/2004)