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Parsons Jr, James NEW YORK STATE DEPARTMENT OF HEALTH / Vital Records Section Burial - Transit Permit hi Mi Name First Middle Last Sex James W. Parcnnc ,it Male Date of Death Age If Veteran of U.S. Armed Forces, 03/18/2006 0 years War or Dates 22 Years Of Service # ? Place of Death Hospital, Institution or City, Town oXthIgRXXXX City Of Glens Falls Street Address CiIpnc Falls kocpitai Manner of Death❑N' tural Cause 0 Accident 0 Homicide 0 Suicide �Undetermined 0 Pending in Circumstances Investigation W Medical Certifier Name Title iP Sean Bain M n Address Glens Falls Hospital, Glens Falls, N Y Death Certificate Filed District Number Register Number City, Town oxXItttggxxxx City Of Glens Falls 5601 121 DBurial Date Cemetery or Crematory 03/20/2006 Pine View Crematorium ❑Entombment Address OCremation Queensbury, NY 12804 Date Place Removed '' Removal and/or Held ❑and/or F.' Address Cl) Hold O Date Point of t1x❑ Transportation Shipment ct by Common Destination Carrier Q Disinterment Date Cemetery Address Q Reinterment Date Cemetery Address 1< Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home, Inc. 00453 Address 7 Sherman Ave. Corinth, NY 12822 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above '„ Address CC ILI !." Permission is hereby granted to dispose of the human remains describ d e a indi d Date Issued 03/20/2006 Registrar of Vital Statistics / /ZQ/ae; (signature) District Number © Place /, /�J /07' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Ili Date of Disposition 3' .. 6!, Place of Disposition /0 i 1A Li,, , Cic, 2M ji-t4R,1 0 (address) L U) CC (section) (lot number) (grave number) CI Name of Sexton or Person in Charge of Premises BAR Li 64-Z,A/4 (please print) i Signature G o_ Title Cs"/Q .�/1'!9 1?�IZ (over) DOH-1555 (02/2004)