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McGrath, Peter it l NEW YORK STATE DEPARTMENT OF HEALTH tio Vital Records Section Burial - Transit Permit F Name First Middle Last Sex x. Peter Thomas McGrath Male ,• Date of Death Age If Veteran of U.S. Armed Forces, 1 ; June 28,2014 44 War or Dates Place of Death Hospital, Institutioriirondack Tri-County Health Care Z. City, Town or Village Johnsburg Street Address Center lit za Manner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending T Circumstances Investigation i Medical Certifier Name Title Thomas Warrington , = Address HIHIN,Johnsburg,NY 12843 z.- Death Certificate Filed District Number Register Number .r City, Town or Village Johnsburg 5655 ) Zo ❑Burial Date Cemetery or Crematory ❑Entombment June 30,2014 Pine View Crematory Address ©Cremation 21 Quaker Rd., Queensbury,NY 12804 Date Place Removed ZZ n Removal and/or Held and/or Address H Hold U) 0 Date Point of a. y Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address `s 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 il Remains are Shipped, If Other than Above gjAddress at e Permission is hereby granted to dispose of the human rem ' described ab as indic ed. Date Issued -) 4, Registrar of Vital Statistics 0 , (signature) ,; District Number 5655 Place Johnsburg , I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: LuDate of Disposition -7-1-I' Place of Disposition ,� � Cf�4, or--.- W (address) CO QIt (section) (rot number) (grave number) Name of Sexton or Person i Charge of Premises , r.i JOANtf Z (please print) W (AK (pf Signature cA- Title /" (over) DOH-1555 (02/2004)