Macduff, Earl John Jr. , •, # I
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Earl John MacDuff Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/31/2022 75 Years War or Dates 1968-1970
Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address 3 Broad Street,Glens Falls,New York 12801
p Manner of Death I I Natural Cause Accident ElHomicide lilSuicide ]Undetermined ]Pending
V ' 1 I (Circumstances I 'Investigation
W Medical Certifier Name Title
CI Paul Bachman MD
Address
9 Carey Rd,Queensbury Town,New York 12804
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 663
H Burial Date Cemetery,Crematory or Facility Name
01/04/2023 Pine View Crematory
Entombment Address
IIICremation Queensbury Town,New York
lilDonation
•
0❑Removal Date Place Removed
and/or and/or Held
Hold Address
N
0
CL Date Point of
U) Transportation
by Common Shipment
Carrier Destination
O
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
g Address
CC
LU
0" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/03/2023 Registrar of Vital Statistics Megan
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition t(I Z3 Place of Disposition rid
2 (address)
W
CC N
(section) A
r(lot number) (grave number)
aName of Sexton or Person in Charge of Premises ' � t
Z 1please print/
W Signature "/ Title (
DOH-1555(07/18)p 1 of 2
Jl 5rr.
Public Health Law Sec. 4145(2b)
Receipt
Human remains of ' delivered on , 20
Pine View Cemetery - Representing the funeral home named on burial Rermit
Official Funeral Directors Reg.or License#