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Macpherson, David . . , "0 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit ermit Name First Middle Last Sex navid A. MACPHERSON Male <s Date of Death Age If Veteran of U.S. Armed Forces, 9` 1--2012 62 War or Dates 1_9A9-1 973 } Place of Death Hospital, Institution or VAMC ALBANY NEW YORK City, �� � Albany Street Address 1 13 Holland Ave 0 Manner of Death©Natural Cause Accident Homicide �Suicide Undetermined Pending W. Circumstances Investigation tu Medical Certifier Name Title J. Lee Address M_D_ 113 Holland AvP_ Ei Death Certificate Filed District Number Register Number '; City, TNyittlgo Albany 1 98 1 08 ['Burial Cemetery or Crematory 09;07/2012 Pine View Crematory 4i1DIEntombment Address (Cremation Queensbury, New York Date Place Removed Z Removal and/or Held ❑and/or Address F' Hold th Date Point of 0 Li Transportation Shipment G by Common Destination iig Carrier Q Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number iii Name of Funeral Home Kilmer _.Funeral Home 01 078 iiE Address 136 Main St. , S. Glens Falls, NY 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address X tt CL mi Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 9,. 1.. 201 2 Registrar of Vital Statistics James Arrington, (signature) District Number 1 98 Place DVAMC Albany, NY ladoct .::: I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: k. tI Date of Disposition 1-10-Iti Place of Disposition ?,LVi,a., Cr -ttr4, 2 (address) Iti CC (section) i (lot number) (grave number) 0 1,)i� 0 Name of Sexton or Person in Charge of Premises r Sep.• (1 akilplease print) i1 Signature - Title Cnfil> d at (over) DOH-1555 (02/2004)