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MacDonald Sr, Richard 1 # rid-7 NEW YORK STATE DEPARTMENT OF HEALTH* Vital Records Section Burial - Transit Permit Name First Middle Last Sex Richard E. MacDonald Sr. Male Date of Death Age If Veteran of U.S. Armed Forces, October 3, 2015 89 War or Dates fgyy—i 9gb Place of Death Hospital, Institution or g , City, Town or Village Glens Falls Street Address 43 Ridge Street Ti„ Manner of Death© Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined n Pending Circumstances Investigation i Medical Certifier Name Title R6bect ft. 3 . M. 'b . Address %/00 3r®aci <56 2) G4ensCalls . My / so/ Death Certificate Filed District Number F� n t ` Register Number� Z City, Town or Village Glens Falls 1\1JV El Burial Date Cemetery or Crematory • N /0 1 b Co I2-OI S Pine View Crematory ❑Entombment Address ®Cremation Quaker Road Queensbury,NY 12804 ;- Date Place Removed ❑ Removal and/or Held and/or Address Hold Date Point of 1111Transportation Shipment by Common Destination 41; Carrier ❑ Disinterment Date Cemetery Address 4i El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M.B. Kilmer Funeral Home- SGF 01078 SI---',- Address 136 Main Street, South Glens Falls NY 12803 a Name of Funeral Firm Making Disposition or to Whom !':,,s Remains are Shipped, If Other than Above Address ', Permission is hereby granted to dispose of the human re ains d scribed above as indicate . Date Issued iol(,�(e wi 5 Registrar of Vital Statistics _�� "� ..jsi ure) District Number 56,U / Place i Y certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition /o/jlic Place of Disposition Quaker Road Queensbury,NY 12804 (address) (section) /t (lot number) (grave number) Name of Sexton or Person in Charge of Premises hu. L- .fie.. please print) Signature A✓6.- Title 6 ' it (over) DOH-1555 (02/2004)