McClenahan, Scott NEW YORK STATE DEPARTMENT OF HEALTH 371
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Scott Michael McClenahan Male
Date of Death Age If Veteran of U.S. Armed Forces,
May 21,2015 64 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
• Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
w Medical Certifier Name Title
0 Robert W. Sponzo MD
Address
102 Park St,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village C/O Glens Falls 5601 `,7 f
❑Burial Date Cemetery or Crematory
May 26,2015 Pine View Crematory
Ei Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
Cl)
O Date Point of
N Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
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
2 Address
cc
ElJ
a.] Permission is he eby ranted to dispose of the human remains described above as indicated.
Date Issued ,Registrar of Vital Statistics _
ignature)
District Number ; 4/ Place C/O Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition f/26116 Place of Disposition , C ,
(address)
N
rt (section) A(lot number)e. (grave number)
Q Name of Sexton or Person in Charg of Premises thi,t1pL, J A
(phase print)
W Signature Title II7.r�ry►}�7J1
(over)
DOH-1555 (02/2004)