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McFarlane, Ronald S
NEW YORK STATE DEPARTMENT OF HEALTH `. Burial - Transit Permit Bureau of Vital Records - Name First Middle Last Sex Ronald S McFarlane Male Date of Death Age If Veteran of U.S.Armed Forces, 12/01/2021 66 Years War or Dates 1_, Place of Death Hospital,Institution or W City,Town or Village Corinth Town Street Address 78 Heath Road,Corinth Town,New York 12823 p Manner of Death ©Natural Cause El Accident El Homicide El Suicide 0 Undetermined ❑Pending W Circumstances Investigation C.) W Medical Certifier Name Title CI William Kufs MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Corinth 4553 24 ❑Burial Date Cemetery,Crematory or Facility Name 12/07/2021 Pineview Crematory Entombment Address ElCremation Queensbury Town,New York EIDonation Z ❑Removal Date Place Removed - and/or and/or Held H- Hold Address CO 0 Date Point of N ❑Transportation Shipment p by Common Carrier Destination El Disinterment Date Cemetery Address Date Cemetery Address 0 Reinterment Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped,If Other than Above 5-1 Address CC 111 C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/06/2021 Registrar of Vital Statistics Brenda L Penis(Electronically Signed) (signature) District Number 4553 Place Corinth, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ` /� ~ J (* -_-- W (address) l Date of Disposition (2 ill Place of Disposition y W CD (section) (lot number) (grave number) CC Name of Sexton or Person in Charge of Pre ises �'� lease print) z V1. W Signature Title it DOH-1555(07/18)p 1 of 2 0 m 4 1 Public Health Law Sec. 4145(2b) Receipt Human remains of " delivered on , 20 • Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#