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Mcintyre, Michael Dayton
. _(tf.) A 1 NEW YORK STATE DEPARTMENT OF HEALTH f Burial - Transit Permit Bureau of Vital.Records Name First Middle Last Sex Michael Dayton McIntyre Male Date of Death Age If Veteran of U.S.Armed Forces, 12/30/2023 66 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Whitehall Village Street Address 112 Broadway,Whitehall Village,New York 12887 W Manner of Death Undetermined Pendin W �Natural Cause Accident �Homicide Suicide � � g _ Circumstances Investigation W Medical Certifier Name Title CI Robert Lemieux Coroner Address 415 Lower Main Street, Hudson Falls Village,New York 12839 Death Certificate Filed Town Of Whitehall District Number Register Number City,Town or Village 5766 25 RBurial Date Cemetery,Crematory or Facility Name 01/08/2024 Pine View Crematory Entombment I Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 d Date Point of U) Transportation p by Common Shipment Carrier Destination ODisinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above k .S Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/08/2024 Registrar of Vital Statistics cPatti Gordon(ECectronicaCCy Signed) (signature) District Number 5766 Place Town Of Whitehall I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: II-- Z Date of Disposition I —i`.LC22.4 Place of Disposition R ;y.,�, y,.tM, (,ftf"c,1-cry W 2 (address) W NCC (section) (lot number) (grave number) gName of Sexton or Person in Charge of Premises 3 trrwt > Sc,,,c-,S Z (please print) W Signature Title e..,rf, CI-Ie: DOH-1555(07/18)p 1 of 2 • My �i. `p' '•#'4y t Public Health Law Sec. 4145(2b) Receipt Human remains of _ 'AY- delivered on , 20 Pine View Cemetery Representing the funeral home named on,burial permit Official Funeral Directors Reg. or License# "''