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Armstrong,James Rolland NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James Rolland Armstrong Male Date of Death Age If Veteran of U.S.Armed Forces, 03/19/2020 90 Years Waror Dates 1951-1953 Place of Death Hospital,Institution or W City,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing p Mannerof Death ©Natural Cause Accident Homicide ❑Suicide ❑Undetermined Pending LU Circumstances Investigation U W Medical Certifier Name Title Leonard Gelman MD Address 10421 State Route 40,Granville Town,New York 12832 Death Certificate Filed District Number Register Number City,Town or Village Granville 5756 16 ❑Burial Date Cemetery,Crematory or Facility Name 03/23/2020 Pine View Crematorium Entombment Address QCremation Queensbury Town,New York Donation z Removal Date Place Removed and/or and/or Held ~ Hold Address N aDate Point of N ❑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 or to Whom F- Remains are Shipped,If Otherthan Above Address Q W CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/23/2020 Registrar of Vital Statistics ,jenny Linda Wartede(ECectronicaCfy Signed) (signature) District Number 5756 Place Granville, 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 � �- Place of Disposition ress/ W t) (section) (lot numb rl (grave number) g Name of Sexton or Person in Charge of Premis ^"' �' o0 (please print) Z W Signature Title DOH-1555(07/18)p 1 of z Public Health Law Sec. 4145(2b) 0 _3 4 5 1 Receipt Human remains of , ,-', t delivered on r , 20° Pine View cemetery Representing the funeral home named on burial permit �t� Official Funeral Directors Reg.or License# _7