Macnab, Alice YORK STATE DEPARTMENT OF HEALTH y r
s:
A Records Section :E MS
Burial - Transit Permit
Name First Middle Last Sex
Alice H. Macnab Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 30,2013 80 War or Dates
Ir Place of Death Hospital, Institution or
Z City, Town or Village Lake Placid Street Address 10 Dooling Way
pManner of Death X Natural Cause I 'Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 David A.Johnson,MD M.D.
Address
2249 State Rt.86,Saranac Lake,NY 12983
Death Certificate Filed District Number Register Number
City,Town or Village Village of Lake Placid 1523 /
❑Burial Date Cemetery or Crematory
April 5,2013 Pine View Crematory
Entombment
Address
0 Cremation 21 Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
U)
0 Date Point of
N 1 I Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
I IPermit Issued to Registration Number
Name of Funeral Home M.B. Clark,Inc. 01075
Address
2310 Saranac Ave.,Lake Placid,NY 12946
Name of Funeral Firm Making Disposition or to Whom
i- Remains are Shipped, If Other than Above
i Address
W
W
a Permission is hereby granted to dispose of the human reins des ibe above as indicated.
Date Issued 04-01-2013 Registrar of Vital Statistics /a•ti,ite- ,„,/,„. /'
(signet e)
District Number 1523 Place Village of Lake P acid
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z r) ii
w Date of Disposition &-S_t3 Place of Disposition <,,v ii i( a vref
(address)
W
U)
OC (section) � lot numbed (grave number)
oName of Sexton or P rson in Char a of Premises lrA1 n
Z 17(please print)
W 1 Title CtLEMdtC.
Signature .
(over)
4-1555(02/2004)
Ls