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McCane, John Ernest NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John Ernest McCane Male Date of Death Age If Veteran of U.S.Armed Forces, 11/26/2021 73 Years War or Dates 1967-1994 i,. Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending W Circumstances Investigation WMedical Certifier Name Title CI Sean Bain MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 547 ❑Burial Date Cemetery,Crematory or Facility Name 11/29/2021 Pine View Crematory ElEntombment Address X❑Cremation Queensbury Town,New York ElDonation Z 0 Removal Date Place Removed and/or and/or Held F. Hold Address U) 0 O. Date Point of U) ❑Transportation Shipment B by Common Carrier Destination ID Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 1-- Remains are Shipped,If Other than Above 2 Address CC W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/29/2021 Registrar of Vital Statistics 14)bert Andrew Curtis(ECectronica1tySigned) (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: Date of Disposition //o?9,1Va J Place of Disposition a e (1. G.J Cry 4;4 t.S 111 2 (address) W U) (section) (lot number) )] (grave number) � � M � S Name of Sexton or Person in Charge of Premises it(Pia,)4J' 6 6 u Z (please print) W Signature9)//i/ Title CeP - u DOH-1555(07/19)p t of 2 1: g153t2 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# '