Cabral, James --------
'fir'',1 Name First Middle Last Sex
James John Cabral Male
!:a Date of Death Age If Veteran of U.S. Armed Forces,
December 11, 2017 61 War or Dates
•
tPlace of Death Hospital, Institution or
_ Ci Town or Village
W Lingsbury Street Address 591 Vaughn Road
14 Manner of Death Eu Natural Cause Ei Accident Homicide El Suicide Undetermined ri Pending 15 Circumstances Investigation
W, Medical Certifier Name Title
Address
Death Certificate Filed District Number Register Number
City, Town or Village c 7 ( .1- )- (6
40❑Burial Date Cemetery or Crematory
December 13, 2017 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
iT Date Place Removed
Removal
, , and/or and/or Held
Hold Address
Pine View Crematorium
Date Point of
Transportation Shipment
) by Common Destination
i ' Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address i El
! Permit Issued to Registration Number
._ Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
$' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued j3-/i3, 77 Registrar of Vital Statistics aira%
(signature)
I District Number ) lQ) Place -TOW,t 61 k, /1S f b tiry
kia
I certify that the remains of the decedent identified above were disposed of in accordanpe with this permit on:
�' t' Y,YlGv. (J 44 CG/ t/D
ui Date of Disposition 12/ (2017 Place of Disposition Quaker Road Queensbury,NY 12804
w .`, (address)
Uil
(section) k (lot n ber) (grave number)
let Name of Sexton or r on i Charge of Premises w 1 -✓� j✓✓� �
(please print)
Signature Title G•t41.rw>4-----.
(over)
DOH-1555 (02/2004)