Flanagan, Michael 37Z
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Michael F. Flanagan Male
Fs Date of Death Age If Veteran of U.S. Armed Forces,
May 15,2016 65 War or Dates
6 Place of Death Hospital, Institution or
iStreCity, Town or Village Glens Falls
et Address Glens Falls Hospital
® Manner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending
Circumstances Investigation
,° Medical Certifier Name Title
g Douglas Girling
Address
4 GFH,Glens Falls,NY 12801
Death Certificate Filed District Number Reg to Number
City, Town or Village ccJJ V)
m 9 C/O Glens Falls 5601
❑Burial Date Cemetery or Crematory
❑Entombment May 17,2016 Pine View Crematory
Address
EI Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
L" Hold
to
0 Date Point of
ct 0 n Transportation Shipment
6 by Common Destination
Carrier
Disinterment Date Cemetery Address
I
Reinterment Date Cemetery Address
frw Permit Issued to Registration Number
gti=. 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
Remains are Shipped, If Other than Above
Address
14
Ail
0,1 Permission is hereby granted to dispose of the human r mains d cribed above as indi ated.
`
e Date Issued Registrar of Vital Statistics a G12_,.
k . (signa ure)
=F District Number 5601 Place C/O Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition Stip fit. Place of Disposition tv,)J..� (49.441.41 z--
W (address)
U)
pCe (section) �%(lot number)r, (grave number)
Name of Sexton or Person in Charge of Premises ,rc .�.)1/441
Z (pledse print)
W Signature C�`- % Title MAW--
(over)
DOH-1555 (02/2004)