McDonald Jr, Richard NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section ,
Name First Middle Last Sex
RICHARD H. MCDONALD JR. MALE
Date of Death Age If Veteran of U.S.Armed Forces,
05/26/2014 54 War or Dates
1- Place of Death Hospital, Institution
Z City,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
in Manner of Death Natural Undetermined Pendin
LU ® Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ ❑ g
Circumstances Investigation
W Medical Certifier Name Title
0 LEWIS W. BRITTON IV M.D.
Address
43 NEW SCOTLAND AVE ALBANY, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1009
Date Cemetery or Crematory
❑ Burial 05/29/2014 PINEVIEW CREMATORY
❑ Entombment Address
® Cremation QUEENSBURY, NY
Date ` Place Removed
Z Removal and/or Held
Q ❑ and/or Address
H Hold
U)
Q Date Point of
a Transportation Shipment
CO ❑ By Common
6 Carrier Destination ,
❑ Date Cemetery Address
Disinterment
❑ Date Cemetery Address
Renterment
Permit Issued To Registration Number
Name of Funeral Home DENSMORE FUNERAL HOME INC. 00448
Address
7 SHERMAN AVE CORINTH, NY 12822
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
re
Q Permission is hereby granted to dispose of the human remains described above as indicated.
Date 05/28/2014 Registrar of Vital Statistics �--- �`" ea 511
Issued P—Q4044-L-
nature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 5lil IN Place of Disposition 47w1).6.+' e*i42r.+-•-
I (address)
w
cc (section) lot number (grave number)
0
ZI'' Name of Sexton or Person in Charge of Premises "ai l &d
w (please print)
Signature h Title cefolfriot
(over)
DOH-1555 (02/2004)