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McKittrick, Richard 'y # 370 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Richard Gordon McKittrick Male Date of Death Age If Veteran of U.S. Armed Forces, June 17, 2011 69 War or Dates N/A Place of Death Hospital, Institution or Z City, Town or Village Albany Street Address St. Peter's Hospital LU Q Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation u Medical Certifier Name Title G? John D. Filippone,MD Address 2 Palisades Drive.,Albany,NY 12205 ';' Death Certificate Filed District Numbe0101 Register Number City, Town or Village City of Albany 11 re ❑Burial Date Cemetery or Crematory ❑Entombment June 23, 2011 Pine View Crematory Address 0 Cremation Queensbury, NY Date Place Removed Z Removal and/or Held and/or Address F_ Hold N 0 Date Point of N Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address :.= Permit Issued to Registration Number < Name of Funeral Home Carleton Funeral Home, Inc. 00276 -: Address s 68 Main Street, PO Box 67,Hudson Falls, NY 12839 y Name of Funeral Firm Making Disposition or to Whom N Remains are Shipped, If Other than Above 3 Address att a. Permission is hereby granted to dispose of the human remains described above as indi d. Date Issued 6`a© '11 Registrar of Vital Statistics 4.:�! C, ,, _i (signs ure) / / ' ' District Number 0101 Place City of Albany I certify that the remains of the decedent identified above were disposed of in accordance� with this permit on: wDate of Disposition i, /24 hi Place of Disposition P,�L./ C rt,ftsc'(7rr lad%-. 2 (address) LU CL' (section) (lot numbP�r) (grave number) p' Name of Sexton or Pers in Charge Premises ari,,11.,r -Sr Ant Z (please print) W Signature Title CRV P.)0 . (over) DOH-1555 (02/2004)