McManus, Francis NEW YORK STATE DEPARTMENT OF HEALTH, _ 71 v 6°
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Francis ,Toseph McManus Male
Date of Death Age If Veteran of U.S. Armed Forces,
09/07/201 6 82 War or Dates 1 952-55
f. Place of Death Hospital, Institution or
Glens Falls Glens Falls Hospital
Wit, Town or Village Street Address
Manner of Death 0 Natural Cause ❑Accident ❑Homicide E Suicide Undetermined Pending
I.U. Circumstances Investigation
ILI Medical Certifier Name Title
0. Stephen Perizzelli MD
Address
100 Park St. Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
Town or Village Glens Falls, 5 h 0 a L1 5 2
❑Burial Date 0 9/0 7/2 01 6 Cemetery or Crematory
Pine View Crematorium
['Entombment Address
Aii®Cremation Quaker Rd. Queensbury, NY
Date Place Removed
• Removal and/or Held
2 and/or Address
I* Hold
f
0 Date Point of
EL ri
Transportation Shipment
C by Common Destination
Carrier
Hg ElDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
a ElPermit Issued to MB Kilmer Fh Registration Number
Name of Funeral Home 01 078
Address
136 Main St. So. Glens Falls, NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
LU
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 7 / 7 1/6 Registrar of Vital Statistics VJ Ca, z U/.J
(signatur
District Number S G 0 l Place C' l'A"-S ro\ „c) . /V
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ILI• Date of Disposition 9 �;�/b Place of Disposition ��,r,u 4tr✓ crM ort.--,
2 (address)
la
U)
CC (section) / (lot number) (grave number)
Name of Sexton or Person in Char of PremisesZ
`f`r �w�
( lease print)
• Signature a Title a tl e,,
(over)
DOH-1555 (02/2004)