McElroy, John I. . 1
4%7
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section ' Burial - Transit Permit
Name First Middle Last Sex
John McElroy Male
Date of Death Age If Veteran of U.S. Armed Forces,
09 / 14 / 2017 90 War or Dates 1946-1947
ffi
} Place of Death Hospital, Institution or
jCity, Town or Village Wilton Street Address 15 Peach Tree Lane
a Manner of Death®Natural Cause ❑Accident 0 Homicide 0 Suicide ❑Undetermined 7 Pending
ILI Circumstances Investigation
tii Medical Certifier Name Title
Q Jennifer L. Keefer MD
ft
Address
2537 State Route 9 Ste 203 Malta, NY 12020
giiiii Death Certificate Filed District Number Register Number
>< City, Town or Village Wilton
OBurial Date Cemetery or Crematory
09 / 14 / 2017 Pine View Crematory
(Entombment Address
ECremation Queensbury, NY
Date Place Removed
Z❑Removal and/or Held
and/or Address
Hold
0 Date Point of
tiA Q Transportation Shipment
ill by Common Destination
Carrier
iiiiiii'Q Disinterment Date Cemetery Address
s Reinterment Date Cemetery Address
• >< Permit Issued to Registration Number
ag Name of Funeral Home Compassionate Funeral Care 00364
Address
i;!I]i11 402 Maple Ave., Saratoga Sp., NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
. Address
i1
to
Permission is hereby granted to dispose of the human remains described above as indicated.
<' Date Issued Registrar of Vital Statistics / //(, (IN
signature)
gg
iM District Number ZfiX Place ' Wilton , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
LLDate of Disposition q 131n Place of Disposition Q.,{L&.i 4046ri..,
2 (address)
l
ta
it (section) / (lot number) (grave number)
0 Name of Sexton or Person ip Charge of Pre ises ��� Stha
(pie a print) •
Signature it 5Title - MAA j &
(over)
DOH-1555 (02/2004)