McAllister, Charles ro /
NEW YORK STATE DEPARTMENT OF HEALTH - V
Vital Records Section Burial - Transit Permit
`= Name First Middle Last Sex
Charles R. McAllister Male
Date of Death Age If Veteran of U.S. Armed Forces,
.. December 5,2016 82 War or Dates Korean
f Place of Death Hospital, Institution or
City, Town or Village Thurman Street Address 435 Bowen Hill Rd.
" Manner of Death Undetermined Pending
I XI Natural Cause Accident Homicide Suicide
Circumstances Investigation
Medical Certifier Name Title
O Paul Bachman
Address
3767 Main Street,HA N,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village Thurman 5659 CM
❑Burial Date Cemetery or Crematory
Entombment December 12,2016 Pine View Crematory
Address
®Cremation Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
H Hold
N
O Date Point of
NI !Transportation Shipment
6 by Common Destination
Carrier
Disinterment Date Cemetery Address
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
c Remains are Shipped, If Other than Above
M. Address
le
tit
4. Permission is hereby ranted to dispose of the human rem ' described above as in icated.
Date Issued oz. / Registrar of Vital Statistics a-42L[_f' Pi. Q-C.(ic.-�
(si�jnatur
District Number 5 5 9 Place C�kj r) o p LI rm a n
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z �� ,
W Date of Disposition iZV/��/(p Place of Disposition i '1L� 'e(4) e- CGey,c,,icf'y
2 (address) /
W
U)
0 (section) % lot number) (grave number)
Op Name of Sexton P in Charge of Premises �- !r�.44. 4 c G-6,h..F
Z (please print)
W Signature Title L/V.- c,740
(over)
DOH-1555 (02/2004)