MacDuff, Cody `id
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section � � �' Burial - Transit Permit
• Name First Middle Last Sex
Cody Ryan MacDuff Male
s Date of Death Age If Veteran of U.S. Armed Forces,
07/25/2018 24 Years War or Dates
Place of Death Hospital, Institution or
LU
City, Town or Village Glens Falls Street Address Glens Falls Hospital
0 Manner of Death®Natural Cause El Accident El Homicide El Suicide El Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
In Frances Bollinger MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
3...j City, Town or Village Glens Falls 5601 357
OBurial Date Cemetery or Crematory
07/31/2018 Pine View Crematorium
• ❑Entombment Address
j]Cremation Queensbury Town, New York
Date Place Removed
0❑Removal and/or Held
F- and/or Address
- Hold
0 Date Point of
it ❑Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address' El
tt Date Cemetery Address
, ❑Reinterment
.. 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
Address
C
W'
a" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07126/2018 Registrar of Vital Statistics ,p6cr ,-1 Curtis E etronicail Signed")
(signature)
_� 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:
Z
W
Date of Disposition /131 fig Place of Disposition Px� �r ,w
2 (address)
Cn
CC (section) (lot n ber) (grave number)
p Name of Sexton or Person in Charge o Premises [ hrj L 3 e *t
(please priht)
At Signature �( G Title 01444101i
(over)
DOH-1555 (02/2004)