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Hirst, James Tracy NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James Tracy Hirst I Male Date of Death Age If Veteran of U.S.Armed Forces, 11/17/2019 84 Years War or Dates 1958-64 F Place of Death Hospital,Institution or W City,Town or Village Albany Street Address Albany Medical Center Hospital p Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation V W Medical Certifier Name Title Donald Tessitore NP Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 2486 Burial Date Cemetery,Crematory or Facility Name 11/20/2019 Pine View Crematorium Entombment Address 0 Cremation Queensbury Town,New York Donation z Removal Date Place Removed and/or and/or Held ~ Hold Address N O d Date Point of N 0 Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition orto Whom �. Remains are Shipped,If Other than Above Address Ir W 0' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/20/2019 Registrar of Vital Statistics DanieCCeSGiltespie(ErectronicaCCySigned) (signature) District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F- W Date of Disposition j Z Place of Disposition ���� uj (address) W U) (section) (lot number) (grave number) Ir aName of Sexton or Person iq Charge of remises J ���' erV p� Z 2 f (please print) LLJ Signature -� �6A �� Title � DOH-1555(o7/18)p 1 of 2 i Public Health Law Sec. 4145(2b) 013094 i Receipt Human remains of € . }% ' delivered on , 20 T fJ r j, j Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# i