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McGowan Sr.,James Emery NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James Emery McGowan Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 11/07/2019 55 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital WW Manner of Death © Natural Cause F—]Accident F�Homicide Suicide E]Undetermined �Pending U Circumstances Investigation QLLJ Medical Certifier Name Title Carlos Ares MD Address 211 Church St,Saratoga Springs, New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 592 Burial Date Cemetery,Crematory or Facility Name 11/12/2019 Pine View Crematory Entombment Address FRI Cremation Queensbury Town,New York Donation © �Removal Date Place Removed and/or and/or Held ~ Hold Address to 0 Q- Date Point of to Transportation Q by Common Shipment Carrier Destination Disinterment Date Cemetery Address ❑Reinterment 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 Remains are Shipped,If Other than Above 2 Address cc uJ — n Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/08/2019 Registrarof Vital Statistics John Paul Franck(Electronically Signed) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ,�,Date of Disposition �� IZ (� Place of Disposition V, J�rut— W (address) W M (section) (lot number) (grave number) SName of Sexton or Person in Charge of Premises r' " Z please print/ W Signature __ Title � }�(- DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013067 i Receipt Human remains of -._, ' delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#