McGuire, James • e . , 4 56/
NEW YORK STATE DEPARTMENT OF HEALTH. ...
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
James William McGuire Male
Date of Death Age If Veteran of U.S. Armed Forces,
06/24/2017 76 Years War or Dates 1958-1962
1- Place of Death Hospital, Institution or
WCity, Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death Natural Cause Accident Homicide Suicide 0 Undetermined D Pending
Circumstances Investigation
W Medical Certifier Name Title
a Michael Fuller MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 354
`1-g1DBurial Date Cemetery or Crematory
06/29/2017 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York
Date Place Removed
Z❑Removal and/or Held
I--
and/or Address
Hold
Date Point of
NLiTransportation Shipment
G by Common Destination
1..s Carrier
; Q Disinterment Date Cemetery Address
❑Renterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
t-. Remains are Shipped, If Other than Above
a Address
Ce
W
g!' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/28/2017 Registrar of Vital Statistics koae.c,t Curtis Ectronicaaysigned
(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 7 I c I fl Place of Disposition e e--
2 (address)
W
CO
W (section) (l�oj number) (grave number)
0
Name of Sexton or Person in Charge of Premises please
z please tint) _
WSignature N Title C itta'l_
(over)
DOH-1555 (02/2004)