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McBride, John Francis it- )11i NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Pernlit Bureau of Vital Records Name First Middle Last Sex John Francis McBride Male Date of Death Age If Veteran of U.S.Armed Forces, 11/08/2020 77 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital ILI W• Manner of Death © Natural Cause ❑Accident ❑Homicide Suicide Undetermined El Pending U Circumstances Investigation WLU Medical Certifier Name Title Shahid Ahmed MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 507 ❑Burial Date Cemetery,Crematory or Facility Name 0 Entombment Address ❑Cremation 0 Donation Z Date Place Removed 0 Q Removal 11/12/2020 and/or and/or Held M.B.Kilmer Funeral Home Hold Address CO Q South Glens Falls Village, New York a. U) ❑Transportation Date Point of p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address CIC LLI n Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/12/2020 Registrar of Vital Statistics q4)6ertAndrew Curtis(ECectronicalTy Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H' j W' Date of Disposition il'�'] 70 Place of Disposition ti.l(.._ C1 2 (address) 11.1 CC (section) 4(lot number/ (grave number) • Name of Sexton or Person in Charge of P ises G f L ��P/Amat Z /�� (ple4e print) W Signature LJI� �— g Title IliktitrAtDOH-1555(07/18)p i of 2 Public Health Law Sec. 4145(2b) 0 1 Receipt Human remains of delivered on , 20— Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#