McIntyre, Donald NEW YORK STATE DEPARTMENT OF HEALTH �("v
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Donald "Ditto" McIntyre Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 15, 2014 87 War or Dates World War II
�° Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 4 Meadow Drive
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`;p Manner of Death I XI Natural Cause I ]Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
gi Gerald F Abess
Address
3 Irongate Center,Glens Falls,NY 12801
Death Certificate Filed District Number Regier Number
City, Town or Village Queensbury 5657
® ❑Burial Date Cemetery or Crematory
❑Entombment July 18, 2014 Pine View Crematorium
Address
111 Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
U)
O Date Point of
g5 n Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
:;:; Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
°' 53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
,;.$ Remains are Shipped, If Other than Above
Address
,t1J
Permission is hereby granted to dispose of the huma reklai s deN!crib ov indi ated.
Date Issued I-e iii Registrar of Vital Statistics
(signatu
•
District Number 5657 Place Queensbury
I certify that the remains of the decedent identified above were disposed ofofp in accordance with this permit on:
W Z(� 4 Date of Disposition -)` Z Place of Disposition L. Ce AN.A...-
2 (address)
W
N
cc (section) /LAIL(lot number) , (grave number)
Op Name of Sexton or Person in C arge of Premises 3/444
`Z (pldase print)
Signature Title CO i)
(over)
DOH-1555(02/2004)