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Dingman, James F.
q NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James F Dingman I Male Date of Death Age If Veteran of U.S.Armed Forces, 01/09/2020 64 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address 30 Oneida Street,Glens Falls,New York 12801 pManner of Death Natural Cause Accident Homicide ©Suicide Undetermined Pending W Circumstances Investigation WMedical Certifier Name Title Connie Goedert Coroner Address 1400 St Route 9,Lake George Town,New York 12845 Death Certificate Filed District Number Register Number City,Town orVill Glens Falls 5601 28 ❑Burial Date Cemetery,Crematory or Facility Name 01/14/2020 Pine View Crematory Entombment Address X❑Cremation Queensbury Town,New York Donation Z Removal Date Place Removed pand/or and/or Held N Hold Address Transportation Date Point of by Common Shipment Carrier Destination Disinterment Date Cemetery Address nt Reinterme Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition orto Whom IF- Remains are Shipped,If Otherthan Above 2 Address Q W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/14/2020 Registrar of Vital Statistics WpbertAndirew Curtis(Efectronicaffy Signed (signature) I District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition Ib 7b Place of Disposition t /- 7r&L— W (address/ 2 W (sectwn) (tot number) (grave number) Name of Sexton or Person in Charge of Premises Z /ease print/ W Signature Title DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1 r 012246 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#