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Burton, James W.
a 307 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James W.Burton Male Date of Death Age If Veteran of U.S.Armed Forces, 04/03/2020 75 Years War or Dates F Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W p Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Matthew Loftus PA Address 100 Park St,Glens Falls, New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 157 ❑Burial Date Cemetery,Crematory or Facility Name 04/04/2020 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation 0 Removal Date Place Removed and/or and/or Held F-N Hold Address O a Date Point of U) Transportation p by Common Shipment Carrier Destination El Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 01199 Address 6357 Nys Rte#30, Indian Lake,New York 12842 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/03/2020 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (signature) 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: F— \ Z Date of Disposition y l y 110 Place of Disposition (K.— W (address) W N (section) (lot number) (� (grave number) M J Name of Sexton or Person in Charge of Premise�s� fta Z C./` (P!e a print) W Signature Title DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) .� 013504 Receipt Human remains of �, 1 �w' " ' v delivered on , 20 ,l Pine View Cemetery epresenting the funeral home named on burial permit Official Funeral Directors Reg.or License#