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McGloin, Maria 5''7 3 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Vital Records Section Y ; '= Name First Middle Last Sex '; . Maria G. McGloin Female % Date of Death Age If Veteran of U.S. Armed Forces, t August 7,2016 74 War or Dates ' Place of Death Hospital, Institution or City, Town or Village Fort Edward Street Address Fort Hudson Nursing Home Manner of Death Natural Cause ❑Accident ❑Homicide ❑Suicide Undetermined n Pending —Circumstances Investigation Medical Certifier Name Title `'` Address Death Certificate Filed District Number Reg' r Number f City, Town or Village Fort Edward,NY 5755 ❑Burial Date Cemetery or Crematory August 12, 2016 Pine View Crematorium ❑Entombment Address ©Cremation 51 Quaker Road, Queensbury,NY 12804 Date Place Removed ZZ ri❑Removal and/or Held and/or Address H Hold N O Date Point of N ❑Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 :' Address ''0 407 Bay Road,Queensbury, NY 12804 F Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above �` e Address f - Permission is h re y granted to dispose of the human 'ns described above as Ind' ated. r Date Issued i Registrar of Vital Statistic (signature) District Number57 Place /'d..d J-1- (���c%f(..Jr I certify that the remains of the decedent identified a ove were disposed of in accordance with this permit on: W Date of Disposition �,//'2//lp Place of Disposition /i A�Ul�� 'le-ill G-fh/y 2 `'l (address) W CO Ce (section) t (lot number) (grave number) pName of Sexton o e on • Charge of Premises t.I i--rc el.-yrt 4c-e Z (please print) W Title Lfa-Ale-'fir' Signature �' (over) DOH-1555(02/2004)