McMahon, Francis 11
NEW YORK STATE DEPARTMENT OF HEALTH ?6g Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Francis J. McMahon Male
Date of Death Age If Veteran of U.S. Armed Forces,
May 6, 2013 63 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death n Undetermined n Pending
tit�ti X Natural Cause Accident Homicide Suicide
Circumstances Investigation
Medical Certifier Name Title
Timothy Murphy-Coroner
Address
52 Haviland Ave,Queensbury,NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 p(763
❑Burial Date Cemetery or Crematory
May 9, 2013 Pine View Crematory
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, ,NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
H Hold
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O Date Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
"' Permit Issued to Registration Number
s 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
1' Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains des ribed ab e • icated.
�, �Date Issued 0.S Q,f2D/.3 Registrar of Vital Statistics `��
/ (signature)
District Number SO Place �/t514rig / / J
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition S....1013 Place of Disposition te,,J a 1otc1
W (address)
co
re
(section) of numb r) (grave number)
p• Name of Sexton or Person in Charge of Pr mises f �t� ✓L�W��
Z (please rint)
W i
Signature try.. Title C ytN1:11k)4,
(over)
DOH-1555(02/2004)