McNally, Margaret ,...... _ t 7/ s3g
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial . Transit Permit
Name First Middle Last Sex
Margaret M McNally Female
Date of Death Age If Veteran of U.S. Armed Forces,
• July 22, 2015 63 War or Dates n/a
Place of Death Hospital, Institution or
M City, Town or Village Glens Falls, NY Street Address Glens Falls Hospital
Manner of Death X Natural Cause Accident Homicide Suicide I 'Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
: Scott Biasetti,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register Nber
• City, Town or Village Glens Falls, NY 5601 / '
❑Burial Date Cemetery or Crematory
❑Entombment July 23, 2015 Pine View Crematory
Address
❑x Cremation Quaker Road, Glens Falls,NY 12804 _
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
U)
0 Date Point of
coTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
lN+ Remains are Shipped, If Other than Above
S Address
ig
':.: Permission is hereby g dispose to dis ose of the humatZemains escribed above as in,icated
Date Issued 07 a ably Registrar of Vital Statistics a'(iie.4ky / • A.- l"C...,
(signature)
District Number 5Cao I Place t.._.--2-fg /72.-0)
I certify that the remains of the decedent identified above were disposed of in accordan with this permit on:
W Date of Disposition 7)L9j16- Place of Disposition ' Cc ,-
2 (address)
W
U)
tY (section) (lot number) (grave number)
Q Name of Sexton or Person in Ch rge of Premises I.4.. .Sy..
Z I (please�j Tint)
W
Signature Title Tu,,,kyrk
(over)
DOH-1555(02/2004)