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Fahey,James Frederick
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vita[Records Name First Middle Last Sex James Frederick Fahey Male Date of Death Age If Veteran of U.S.Armed Forces, 01/31/2020 73 Years War or Dates IF- Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 220 Reservoir Road,Moreau Town,New York 12828 Mannerof Death IUU ©Natural Cause Accident ❑Homicide 0 Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Rodney Ying MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Moreau 4562 8 Burial Date Cemetery,Crematory or Facility Name 02/04/2020 Pine View Crematorium Entombment Address Cremation Queensbury Town,New York Donation 0 ❑Removal Date Place Removed and/or and/or Held H Hold Address N O IL Date Point of N ❑Transportation Q by Common Shipment 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 I- Remains are Shipped,If Otherthan Above Address Q W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/04/2020 Registrar of Vital Statistics Geeann We ca6e(ECectronicady Signer (signature/ District Number 4562 Place Moreau, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition Z/s 'W Place of Disposition rt4.�.Wa9-0��ae(address) W Ncc (section/ (lotnumbe (grave number) SName of Sexton or Person in Charge of remises sir Z leaseRntl W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#