MacDonald, Margaret NEW YORK STATE DEPARTMENT OF HEALTH s . - I #y3
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Margaret Mary MacDonald Female
Date of Death Age If Veteran of U.S. Armed Forces,
_`' June 2,2017 90 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Lake George Street Address 48 Upper Hubbell Lane
Manner of Death I XI Natural Cause I l Accident Homicide Suicide 'Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
a Paul Bachman
Address
3767 Main Street,h u N,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village Lake George 5651
❑Burial Date Cemetery or Crematory
June 5,2017 Pine View Crematory
II Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
Cl)
0 -
Date Point of
N Transportation Shipment
p by Common Destination
Carrier
Date Cemetery Address
n Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
.► Remains are Shipped, If Other than Above
Address
f
Permission is hereby granted to dispose of the human remains described abo a as indicated.
Date Issued (p")% —I 7 Registrar of Vital Statistics
(s gnatu
District Number 5651 Place T/O Lake George
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z '
im Date of Disposition &17 117 Place of Disposition f t),J1-_ r*altotri,--
W (address)
CO
p0 (section) //��// (lot number) ` (grave number)
Name of Sexton or Person in Charge of Premises (hrt e �f 1441*
Z A� (please print)
uJ Signature !rt Title Nil
(over)
DOH-1555 (02/2004)