Brower, James NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
<' Name First Middle Last Sex
James B. Brower Male
Date of Death Age If Veteran of U.S. Armed Forces,
3/1/99 77 War or Dates Yes WWII
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death nj Natural Cause El ❑Homicide El Suicide ❑Undetermined Pending
Circumstances Investigation
MILIedical Certifier Name Title
CI Bernardo R. Villajuan MD
Address
90 South St. Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
iiiii City, Town or Village Glens FAlls 5601 /0-5
Date Cemetery or Crematory
❑X Burial 3/4/99 Pine View Cemetery
Address
❑Cremation Quee isbury,NY
Date Place Removed
0 in❑Removal and/or Held
r• and/or Address
0 Hold
2 Date Point of
tR❑Transportation Shipment
fl by Common Destination
Carrier
Di Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny 01565
Address
53 Quaker Rd. Queensbury,NY 12804
M Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
M
4
Mil Permission is hereb granted to dispose of the human remains described above Ind' e
iiiiN
gi
Date Issued (3`Z 95 Registrar of Vital Statistics
Z
(signature)
District Number 5601 Place Glens Falls,NY
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1F
6 Date of Disposition 3/4/99 Place of Disposition Pine View Cemetery , Queens bury , NY
2 (address)
la
N New Kenesaw 10-B 5
CI (section) (lot number) (grave number)
GName of Sexton or Person in Charge of Premises Michael L op e z
g (please print)
44 Signature Title Working Foreman
(over)
DOH-1555 (9/98)