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MacDonald, James H
• leg NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James H.MacDonald Male Date of Death Age If Veteran of U.S.Armed Forces, 02/01/2022 64 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Ticonderoga Town Street Address Elderwood at Ticonderoga p Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title James Gabler PA Address 1019 Wicker St,Ticonderoga Town,New York 12883 Death Certificate Filed District Number Register Number City,Town or Village Ticonderoga 1564 8 ElBurial Date Cemetery,Crematory or Facility Name 02/02/2022 Pine View Crematoriuma ElEntombment Address 0 Cremation Queensbury Hamlet,New York EjDonation ❑Removal Date Place Removed and/or and/or Held N Hold Address 0 a Date Point of co ❑Transportation $ by Common Shipment Carrier Destination Disinterment Date Cemetery Address OReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/02/2022 Registrar of Vital Statistics Tonya 31'Thompson(Electronicalry Signed) (signature) District Number 1564 Place Ticonderoga, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition Place of Disposition �Ji , V�r ,v Ccc4i c >/ ILI g f (address) W CC (section) (lot number) (grave number) SName of Sexton or Pers in Charge of Premises —j—d-in ems? St* 5 (please print) W Signature Q- Title L re,r++- -/or DOH-1555(07/18)pi of 2 ";". 560 Public Health Law Sec. 4145(2b) Receipt Human remains of ;f t' delivered on , 20)-2) Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# 1-