McGregor, Brian A 1, 9 19
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Brian P. McGregor Male
Date of Death Age If Veteran of U.S. Armed Forces,
tr
11/30/2017 56 War or Dates NA
ZPlace of Death Hospital, Institution or
City, Town or Village Glens Falls,NY Street Address 11 Bacon St.Apt#B Glens Falls,NY 12801
,
Manner of Death Natural Cause ❑Accident 0 Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
�wMedical Certifier Name Title
' Paul Bachman MD
Address
Warrensburg,NY
Death Certificate Filed District Number Register umber
City, Town or Village Glens Falls,NY L5��j r ��
❑Burial Date Cemetery or Crematory
11 Entombment 12/04/2017 Pine View Crematory
Address
I Cremation Quaker Rd.,Queensbury,NY
Date Place Removed
ZZ ❑Removal and/or Held
and/or Address
H Hold
N
O Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
El Disinterment Date Cemetery Address
❑Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
I Address
407 Bay Rd.,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
1
Permission is hereby granted to dispose of the human remains desc Vc7b ,
asated.
Date Issued 42/7/20/7 Registrar of Vital Statistics
(signature)
District Number 62/ Place C7 ,® 1::)4 ) ', t
t— I certify that the remains of the decedent identified above were disposed of in accordance� with this permit on:
Lu Date of Disposition 1 to .) 11 Place of Disposition L C- o4br-�
(address)
LLJ
CO
W (section) A (lot number) (grave number)
0 Name of Sexton or Person in Charge of Pr ises GI,h s :,A^Ili
W (p ase print) n
Signature '✓� Title (�,f/fit ja},i
(over)
DOH-1555(02/2004)