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McGuire, Bernard Anthony it z7r NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Bernard Anthony McGuire Male Date of Death Age If Veteran of US.Armed Forces, 02/24/2021 89 Years War or Dates Army • Place of Death Hospital,Institution or W City,Town or Village Queensbury Town Street Address 75 Hicks Road,Queensbury Town,New York 12804 a Manner of Death ©Natural Cause ❑Accident ❑Homicide El Suicide ❑Undetermined 1=1 Pending W 0 Circumstances Investigation al Medical Certifier Name Title Ci David Foote MD Address 340A Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 58 ❑Burial Date Cemetery,Crematory or Facility Name 02/26/2021 Pine View Crematory Entombment Address X❑Cremation Queensbury,New York ❑Donation QEl Removal Date Place Removed and/or and/or Held H Hold Address N 0 d Date Point of co Li Transportation a by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 2 Remains are Shipped,If Other than Above Address CC W C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/26/2021 Registrar of Vital Statistics Caroline 7fi(fegarde Barber(Electronically Signed) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permi • Z 7 W Date of Disposition 3 -Z' Place of Disposition 4, 1 t�� ddress� W CC N (section) 4 (lot number) (grave number) SName of Sexton or Person in Charge of Premises G. 1„`. g kV Z (/T ease print/ W Signature Title N �" DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014592 Receipt 1 Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#