McFarlane, Eric A it q7
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NEW YORK STATEF H "` } L- 'DEPARTMENT E • HEALTH Burial - Transit Permit
Bureau of Vital Records v'
Name First Middle Last Sex
Eric A McFarlane Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/11/2022 48 Years War or Dates •
1.. Place of Death Hospital,Institution or
W City,Town or Village Hadley Town Street Address 222 Hams Road,Hadley Town,New York 12822
p Manner of Death 0 Natural Cause Accident 0 Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
0 David DeCelle Coroner
Address
40 McMaster Street,Ballston Spa,New York 12020
Death Certificate Filed Town Of Hadley District Number Register Number
City,Town or Village 4558 8
Burial Date Cemetery,Crematory or Facility Name
^'9t�f17/2022 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
EIDonatid e
' 1 ''Dante
ZO El Removal Place Removed
oval
a /or and/or Held
F.: old Address
0
O. Date Point of
Cl)aTransportation
p by Common Shipment
Carrier Destination
HDisinterment
Date Cemetery Address
IIReinterment Date Cemetery Address
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
}.. Remains are Shipped,If Other than Above
a Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/14/2022 Registrar of Vital Statistics Colleen Demarsh(Electronically Signed)
/signature)
District Number 4558 Place Town Of Hadley
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Date of Disposition P0I I'►M 21 Place of Disposition -l'1,lc IA_ l ri
W
2 (address)
W
CO
CC (section) i (lot number) (grave number)
0 Name of Sexton or Person in Cha remises t" �—
Z (pleale print)
111 Signature C%' Title (F 44 041R+2
DOH-1555(07/18)pi of 2
r i
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#