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Linehan, Paul NEW YORK STATE DEPARTMENT OF HEALTH ` g 50 Vital Records Section Burial - Transit Permit F Name First Middle Last Sex Paul A. Linehan Male .; Date of Death Age If Veteran of U.S. Armed Forces, November 26, 2016 88 War or Dates Place of Death Hospital, Institution or ut City, Town or Village South Glens Falls Street Address 49 Ferry Blvd 0 Manner of Death FriEli Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined r-i❑ Pending Circumstances Investigation Medical Certifier Name Title O Patricia Auer N.P. Address 161 Carey Rd. Queenshiiry, NV 19804 Death Certificate Filed District Number Register Number City, Town or Village South Glens Falls ❑Burial Date Cemetery or Crematory November 29, 2016 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed • ❑ Removal and/or Held and/or Address p Hold Date Point of • ❑Transportation Shipment O by Common Destination O Carrier Date Cemetery Address III Disinterment Date Cemetery Address El Reinterment Permit Issued to Registration Number Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078 Address 136 Main Street, South Glens Falls NY 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 2 Address fPermission is her by granted to dispose of the human rem" s described above as indicated. Date Issued // o,/l . Registrar of Vital Statistics ` �wac ci �� y�� .I �; (signature) District Number � � Place I"/�� L� ��JLC ( �'l�I� �- �L6- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: la Date of Disposition 11/29/2016 Place of Disposition Quaker Road Queensbury,NY 12804 2 (address) Lit Ca re (section) /' (lot number)e- (grave number) $2 Name of Sexton or Person in Charge of Premises L 14.p�r �'evii#1t please print) W Signature rid' Title (REt` - (over) DOH-1555 (02/2004)