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McCarthy, Richard NEW YORK STATE DEPARTMENT OF HEALTH ti .7 - 2 # V 1 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Richard McCarthy Male Date of Death Age If Veteran of U.S.Armed Forces, 11/27/2017 65 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Saratoga Springs Street Address Saratoga Hospital Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Timothy Waters DO Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City, Town or Village Saratoga Springs 4501 592 ❑Burial Date Cemetery or Crematory 11/28/2017 Pine View Crematory ❑Entombment Address__ NCremation Queensbury Town, New York Date Place Removed ❑Removal _ and/or Held and/or Address i Hold P I Date Point of ❑Transportation Shipment by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/28/2017 Registrar of Vital Statistics yohnq"Franck Efectronica1IySigned- (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 11/30 if) Place of Disposition ett).,,, (- -c4--ort‘_., (address) (section) ir (lot number) (grave number) a Name of Sexton or Person in Charge of remises G"ri Le- ��#t ('ease print) Signature Ivy ' 9 (� Title �� (over) DOH-1555 (02/2004)