McGeoch, Paul NEW YORK STATE DEPARTMENT OF HEALTH `* ; t+ 01
Vital Records Section Burial - Transit Permit
:.,fe Name First Middle Last Sex
w Paul Kenneth McGeoch Male
l ; Date of Death Age If Veteran of U.S. Armed Forces,
, September 20, 2013 77 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Fort Edward Street Address Fort Hudson Nursing Home
Manner of Death X❑ Natural Cause ❑ Accident n Homicide 0 Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
: Medical Certifier Name Title
Address
Death Certificate Filed Distric umber,/ Register Number
City, Town or Village Fort Edward ��
Date Cemetery or Crematory
wi
• ❑Burial September 23, 2013 Pine View Crematory
' `❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
Hold
Date Point of
• ❑Transportation Shipment
by Common Destination
Carrier
• ElDisinterment Date Cemetery Address
El Reinterment
u.
Date Cemetery Address
af Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home 01077
Address
44
123 Main St., Argyle NY 12809
V >'. Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
9f Address
,, Permission is h reby ranted to dispose of the huma ins descri above s indicated.
'k ,� Registrar of Vital Statisti ...
Date Issue / ignature)
t District Numb ? Place
rF
,. . I certify that the remains of the decedent identified abo e were disposed of in accordance with this permit on:
Date of Disposition 09/23/2013 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number)^ (grave number)
S
Name of Sexton or Person incharge of Pre ises ri r IA I
w=-: ( ease print)
MOWN
, M�1►1i4' Signature Title Q
(over)
DOH-1555 (02/2004)