McDermott, Aaron Thomas ( r \
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
max, Name First Middle Last Sex
Aaron Thomas McDermott Male
. Date of Death Age If Veteran of U.S.Armed Forces,
,j
09/26/2022 23 Years War or Dates
Place of Death Hospital,Institution or
City,Town or Village Queensbury Town Street Address 12 Aviation Road,Queensbury Town,New York 12804
Manner of Death ❑x Natural Cause Accident El Homicide Suicide Undetermined Pending
', Circumstances Investigation
Medical Certifier Name Title
`a Charles Yun MD
'  Address
100 Park St,Glens Falls,New York 12801
l'f<, Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 137
Burial Date Cemetery,Crematory or Facility Name
09/28/2022 Pine View Crematory
Entombment_ Address
aCremation Queensbury,New York
Donation
ox
E
Removal Date Place Removed
o'` and/or Held
and/or
fn
Hold Address
Date Point of
Transportation Shipment
by Common
Carrier Destination
.' Date Cemetery Address
Disinterment
s `■ Reinterment
Date Cemetery Address
w
::. 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
Remains are Shipped,If Other than Above
Address
ILi
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/27/2022 Registrar of Vital Statistics Caroline Jfi(degardeBar6erg(ectronicaffySigned)
(signature)
District Number 5657 Place Town Of Queensbury
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1/ /7iti '
k Date of Disposition 9/30I2Z Place of Disposition ..,1,C.. (�C
(address)
(sea/on) number) (grave number)
Name of Sexton or Person in Charge of Premises //0.,./lot
L. IT
/� (pl)se print)
Signature / _ Title71Z �N�11
v �2 f
DOH-1555(07/18)p 1 of 2
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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#