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Walker, James 4 'V NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex James Arthur Walker Male Date of Death Age If Veteran of U.S.Armed Forces, if 01/30/2018 88 Years War or Dates ��; Place of Death Hospital, Institution or • City,Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause ❑Accident El Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation ` Medical Certifier Name Title Scott Biasetti MD Address 100 Park St,Glens Falls,New York 12801 .- Death Certificate Filed District Number Register Number • City,Town or Village Glens Falls 5601 57 ®Burial Date Cemetery or Crematory �, 02/02/2018 Pine View Cemetery �❑Entombment Address ❑Cremation Queensbury, New York Date Place Removed ❑Removal and/or Held °3, and/or Address Hold , Date Point of • ❑Transportation Shipment by Common Destination fii Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 • Address 53 Quaker Rd,Queensbury,New York 12804 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 01/31/2018 Registrar of Vital Statistics WgbertA Curtis(ECectronicallySigned) NV (signature) District Number 5601 Place Glens Falls, New York • I certify that the remains of the decedent identified above were disposed of in a rdance with this permit on: 1 Date of Disposition 212 201 g Place of Disposition 2/ Gwi*_ . ae.04,s LiSdz address)TI fitu, GI, 6 1 Y (*con) (lot number) (grave number) Name of S on or Person i Charge of Premises r (p► print) i., Signature Tr . R6 Title (over) DOH-1555(02/2004)