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McAllister, Adair NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Adair Melvin McAllister Male Date of Death Age If Veteran of U.S. Armed Forces, September 3, 2016 70 War or Dates ZZ Place of Death Hospital, Institution or w City, Town or Village Glens Falls Street Address Glens Falls Hospital CI Manner of Death Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending Circumstances Investigation W Medical Certifier Name Title CI Scott Miller, Dr. Address 100 Broad St#2 Glens Falls, NY 12801 �/�� Death Certificate Filed District Number J,-. Register Number Lib5 City, Town or Village ❑Burial Date Cemetery or Crematory September 8, 2016 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z,❑ Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment CO by Common Destination p Carrier ❑ Disinterment Date Cemetery Address ❑ Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped, If Other than Above 2 Address W CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued Qj /?` / Registrar of Vital Statistics L ) (signature) District Number 5 ( ©, Place 6 L .'As rCA k 5, i L) I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W, Date of Disposition 09/08/2016 Place of Disposition Quaker Road Queensbury,NY 12804 2; (address) W co e (section) Attri'4 (lot number) (grave number) Name of Sexton or Person in Char e of Premises � 514.4. 'z (please print) W' Signature �`� Title (over) DOH-1555 (02/2004)