Mahar Jr., John NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
John D Mahar Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
1. May 6, 2017 5 j, War or Dates
T •
2 Place of Death Hospital, Institution or
W City,Town,or Village Hudson Falls Street Address His home
0 Manner of Death Natural Cause El Accident El Homicide 0 Suicide ❑Undetermined n Pending
W Circumstances Investigation
U Medical Certifier ame Title
W KO ,7 five_ i
0 Address
3 _Trizoti C 0 Gi_g��s Ff,t(S A/Y /a 8-0r
Death Certificate Filed District Number Register Number
City,Town or Village Hudson Falls .-7(p oti 9
❑Burial Date Cemetery or Crematory
May 9, 2017 Pineview Crematorium
❑Entombment Address
JCremation 21 Quaker Road Queensbury, NY 12804
Date Place Removed
0 ii Removal and/or Held
and/or Address
l" Hold
0 Date Point of
0 El Transportation Shipment
d by Common Destination
Carrier
Date Cemetery Address
a 0 Disinterment
•
Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
~ Name of Funeral Firm Making Disposition or to Whom
$ Remains are Shipped, If Other than Above
W Address
a
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued S 'Q- 0 f,i Registrar of Vital Statistics r _ki
(signature)
District Number 5-7( Z Place Hudson Falls,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
Ill Date of Disposition 05/09/2017 Place of Disposition Pineview Crematorium
2 (address)
an
(section
)) A (lot number) (grave number)
d Name of Sexton or Person in Charge of Premises /4rast• kr` - t�ni t
W '' (phase print)
Signature It .4 o Title (R F fib}1�d�
(over)
DOH-1555 (02/2004)