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McCullen, Daniel Michael (--* "it 73 NEW YORKSTATE DEPARTMENT OF HEALTH 0 Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Daniel Michael McCullen Male Date of Death Age If Veteran of U.S.Armed Forces, 01/16/2024 80 Years War or Dates i_ Place of Death Hospital,Institution or Ill City,Town or Village Hudson Falls Village Street Address 8 Fifth Street,Hudson Falls Village,New York 12839 0 Manner of Death ❑X Natural Cause IllAccident ❑Homicide lilSuicide Undetermined Pending IIICircumstances Investigation C.) Medical Certifier Name Title G Robert Lemieux Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed Village Of Hudson Falls District Number Register Number City,Town or Village 5726 3 Burial Date Cemetery,Crematory or Facility Name 01/18/2024 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation goRemoval Date Place Removed and/or and/or Held F— Hold Address CO 0 a Date Point of CO❑Transportation a by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/18/2024 Registrar of Vital Statistics Cynthia ABardin(ECectronica1TySigned) (signature) District Number 5726 Place Village Of Hudson Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition /�0—lay Place of Disposition ��e 4' � �i�r� y/i 4. �2 (address) W CC (section) , (lot nu1m r) (grave number) gName of Sexton or Person in Charge of P miles % ',/rl/'J i"'C4 A Z /I (please print) 111 Signature per. "� �"' / Title c2 ,...., DOH-1555(07/18)p i of 2 ^1787 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#