Dannehy, Michael NEW YORK STATE DEPARTMENT OF HEALTH
3
Vital Records Section A Burial - Transit Permit
Name First Middle Last Sex
Michael J Dannehy Male
Date of Death Age If Veteran of U.S.Armed Forces,F May 3, 2016 81 War or Dates /95"& [F5_5'
2 Place of Death Hospital, Institution or
W City,Town,or Village Argyle Street Address Washington Center
G Manner of Death n Natural Cause Li Accident n Homicide 111Suicide n Undetermined 0 Pending
Circumstances Investigation
(J Medical Certifier Name Title
Dr. Jennifer Hayes, M.D. Dr.
Address
4573 State Route 40 Argyle NY
Death Certificate Filed District Number Register Number
City,Town or Village Argyle 5 756 �a
❑Burial Date Cemetery or Crematory
May 6, 2016 Pineview Crematorium
❑Entombment Address
❑S Cremation 21 Quaker Road Queensbury, NY 12804
Date Place Removed
4 ( I Removal and/or Held
and/or Address
Hold
Date Point of
4 n Transportation Shipment
by Common Destination
Carrier
Date Cemetery Address
0 n Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
Name of Funeral Firm Making Disposition or to Whom
▪ Remains are Shipped, If Other than Above
W Address
0.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued S C) Registrar of Vital Statistics SKS)Sl
S 5//b si frYL
gnature)
District Number .5750 Place Argyle,New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
W Date of Disposition 05/06/2016 Place of Disposition Pineview Crematorium
2 (address)
tt!
Id
(section) (lot number) (grave number)
O Name of Sexton or Person in Charge of Premises An tpl, Siv*! -
W (please print)
Signature a '��, ' Title UMW-
(over)
DOH-1555 (02/2004)