McClure, Eileen IT k56b
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Eileen C. • McClure Male
Date of Death Age If Veteran of U.S.Armed Forces,
F
July 17, 2011 83 War or Dates no
2 Place of Death Glens Falls Hospital, Institution or Glens Falls Hospital
W City,Town,or Village Street Address
0 Manner of Death ®Natural Cause ❑ Accident ❑Homicide Suicide ❑Undetermined ❑ Pending
W Circumstances Investigation
U Medical Certifier Name Title
W , ,e I-- ,C.912 0 /'fri1)
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Death Certificate Filed/ District Number ! / Register Number
City,Town or Village 5 Coo ( 3 ) 1
❑Burial Date July 20, 2011 Cemetery or Crematory
Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury New York 12803
Date Place Removed
0 ❑Removal and/or Held
- and/or Address
I' Hold
0 Date Point of
0 ❑Transportation Shipment
i. by Common Destination
Carrier
Date Cemetery Address
a ❑Disinterment
—
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00897
Address
46 Williams Street, Whitehall, New York 12887
~ Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped, If Other than Above
X
W Address
0.
Permission is hereby granted to dispose of the human remains described above as
s�indicated.
Date Issued -7 I ICI I r I) Registrar of Vital Statistics L' �� A . V
(signature)
District Number 5 60 I Place • E `Q1...--s M I y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F
z
w Date of Disposition 7- zo-t U Place of Disposition w V t C i C'te""41 Ori,ti
2 (address)
W
N
(section) _ (lot numbe (grave number)
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Name of Sexton or Person in Charge of Premises
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Si nature — Title CR �►>, tot�—
9
(over)
)H-1555 (02/2004)