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Ferguson, Paul 39c NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex 1-0 Paul R.Ferguson Mate Date of Death Age If Veteran of U.S.Armed Forces, .05/1-6/2018 175 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause 0 Accident 0 Homicide 0 Suicide rl Undetermined Pending Circumstances Investigation Medical Certifier Name Title Abigail Macomber PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 240 ❑Burial Date Cemetery or Crematory 05/17/2918 Pine View Crematorium (Entombment Address ®Cremation Queensbury, New York Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Q Re interment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address k' Permission is hereby granted to dispose of the human remains described above as indicated. Date-Issued 05/17/2018 Registrar of Vital Statistics Wp6ertA Curtis(ECectronicaity 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: Date of{fiSNosition a I g Place of Disposition (address) (section) lot number) (grave number) ) Name of Sexton or Person in Charge of Premises (p1 se print) Signature Title 1464! (over) DOH-1555(02/2004)