McBride, Michael NEW YORK STATE DEPARTMENT OF HEALTH in
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Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Michael Joseph McBride Male
4-v- 7 Date of Death Age If Veteran of U.S. Armed Forces,
July 20, 2014 75 War or Dates I Civet— let 0
Place of Death Hospital, Institution or f
n City, Town or VillageSatreireja Street Address 10 ' q ll Qj Di let I
Manner of Death IL.] Natural Cause [1] Accident ❑ Homicide ❑ Suicide ❑ Un.-termined ri❑ Pending
Circumstances Investigation
Medical Certifier Name Title
Catherine Dawson,
Address
211 Church Street Saratoga Springs, NY 12866
Death Certificate File District Number Register Number
- City, Town or Village , RQ x,A ��2jNLt4 y j v I 3 1
11 0 Burial Date Cemetery or Crematory n
ine__vlM CfeyA�^ t ,l n
❑Entombment
Address �,:[Cremation �� Q\kakR( Zd QWQ1;14(1 try 1 1�voi-)
Date Place Removed
❑ Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
• ❑ Disinterment Date Cemetery Address
❑ Reinterment Date Cemetery Address
ti
- Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01078
Address
136 Main Street, South Glens Falls NY 12803
Name of Funeral Firm Making Disposition or to Whom
4 Remains are Shipped, If Other than Above
Address
Permission is he[2-z]/
ebyanted to dispose of the human remai esrrib ab° a ' dicated
' Date Issued '- V Registrar of Vital Statistics , l
(signature)
District Number Li j dl Place 3Qsitu Sp arou3
0
• "- I certify that the remains of the decedent identified above were disposed of in ccordance with this permit on:
Date of Disposition 1 1311 Place of Disposition in
: 6r -
(address)
(section) lot number) 3 (grave number)
%j-
,i Name of Sexton or Person in Charge of Premises is AA
/� (pleat print)
44-
Signature /J�-- ��--- Title CIVGIMIIret
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(over)
DOH-1555 (02/2004)