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McComsey, Stevens
E. -N , ((? NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Stevens McComsey I Male Date of Death Age If Veteran of U.S. Armed Forces, September 16,2016 62 War or Dates i Place of Death Hospital, Institution or City, Town or Village Johnsburg Street Address 2542 State Route 8 Manner of Death Undetermined Pending Natural Cause Accident I I Homicide Suicide Circumstances Investigation •u Medical Certifier Name Title Noc Jennifer Donovan Address fl 126 Ski Bowl Road,Johnsburg,NY 12843 Death Certificate Filed District Number 5 t r • Register Number City, Town or Village O� � ❑Burial Date Cemetery or Crematory September 19,2016 Pine View Crematory III Entombment Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z Removal and/or Held and/or Address H Hold CO O Date Point of 1 I Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address • 3 Permit Issued to Registration Number Name of Funeral Home Alexander-Baker Funeral Home 00037 lAddress 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom l + Remains are Shipped, If Other than Above N: Address • Permission is hereby granted to dispose of the human rem ' s described above as indicated. sci._,,,, ,,,,j---e Date Issued "I` ) `Q� I to Registrar of Vital Statistics E) (signature)' District Number 541 Place ►SOU c c v & I certifythat the remains of the decedent identified above were disposed of in accor ance h this permit on: Z p W Date of Disposition 10#1, Place of Disposition irk (;:mcfort`%- W (address) CO tY (section) (lot number) (grave number) pName of Sexton or Person in Charge of Premises `^awit.t 3dwq( Z ( ease print) W Signaturea /6, Title 'rio IA (over) DOH-1555 (02/2004)