McDonald, James NEW YORK STATE DEPARTMENT OF HEALTH -1-, 83
Vital Records Section r Burial - Transit Permit
Mili Name First Middle Last Sex
James E. MCDONAT.T) Male
Date of Death Age If Veteran of U.S. Armed Forces,
`Z (� (L66 74 War or Dates 1954-1957
14 Place of Death Hospital, Institution or
a City, ngE ft Albany Street Address 113 Holland Avenue
Manner of Death®Natural Cause 0 Accident 0 Homicide Suicide Undetermined Pending
l Circumstances Investigation
iti Medical Certifier Name Title
ID Kevin Docyk M.D.
Address
113 Holland Avenue Albany, NY 12208
Death Certificate Filed District Number Register Number
>>a City, TOWINIMINge Albany 1 98 031
['Burial Date Cemetery or Crematory
3/3/2011 Pine View Crematorium
['Entombment Address
i:: ®Cremation 21 Quaker Road Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or
Address
itt Hold
Date Point of
Transportation Shipment
£i. by Common Destination
0. Carrier
Q Disinterment Date Cemetery Address
Q Renterment Date Cemetery Address
iiiiiii Permit Issued to Registration Number
iiiiiiiii Name of Funeral Home Regan and Denny Funeral Service 01464
«= Address
53 Quaker Road Queensbury, NY
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
. Address
la
Permission is hereby granted to dispose of the human mains d scri r*d above ;`s indicated.
02/28/2011
Date Issued Registrar of Vital Statistics mes Arrington
(signa re)
� District Number 1 98 Place DVAMC Albany, NY 1 2208
;:. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i
,I
l Date of Disposition 3-1-t t Place of Disposition ,nt()IN., C('h.`ta n,I_
(address)
in
I
lc (section) /� , number) (grave number)
Name of Sexton or erson in Char a of Premises L/h1
t U (please pint)
Signature Title Crr/P iv,,44-o4-
(over)
DOH-1555 (02/2004)