McNally, Thomas NEW YORK STATE DEPARTMENT OF HEALTH * , ti S'Z7
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Thomas Charles McNally Male
Y Date of Death Age If Veteran of U.S. Armed Forces,
08/13/2014 69 War or Dates Vietnam
a Place of Death Hospital, Institution or
t City, Town or Village Olmstedville Street Address Deceased's Residence
Manner of Death Natural Cause ❑ Accident ❑Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
Ili Medical Certifier Name Title
4h V,S-ctr s s a 6 viri q bGJq i,,,,,„4„...,4:,,,,:7,ni)
iiiy of[9,
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` Deat L , ' icate Filed £/� District Number Register Nu ber
'-, City, own r Village FA I ti► 12Li f 5 5 /
2 ,❑Burial Date Cj ry or Crematory / <
���❑Entombment
08/14/2014 �'me V..i u ) riliiij9/0, a
Address
4Y '®Cremation 6 v - h t/G/ ..e/ M-' /
,.'",Fi Date lace Remove
` '❑ Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
-' by Common Destination
Carrier
a; ❑ Disinterment
Date Cemetery Address
tt
Mai El Reinterment
Date Cemetery Address
'' Permit Issued to Registration Number
Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
Address
9 Pine St/P.O. Box 455 Chestertown NY 12817
`= Name of Funeral Firm Making Disposition or to Whom
" Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human ns described above as indicated.
:; Date Issued a 1 4 - t L--I Registrar of Vital Statistics
(signature)
District Number 1 _ 1 Place 1 L w ti C)-E r-k,i tJ t2L.� A-
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition '//y if'/ Place of Disposition inilR,,r tre—c{or.ti
E (address)
(section) /i (lot number) (grave number)
Name of Sexton or Person in Charge of Premises G1 I^s- 1
(lease print)
L Signature A. Title CIlt/nAt
(over)
DOH-1555 (02/2004)