Webb Jr., James NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
James Paul Webb Jr Male
Date of Death Age If Veteran of U.S. Armed Forces,
01/17/2018 72 Years War or Dates
1 Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death X❑Natural Cause El Accident El Homicide ❑Suicide Undetermined ❑Pending
Circumstances Investigation
uj Medical Certifier Name Title
0 Michael Miles MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 31
❑Burial Date Cemetery or Crematory
01/22/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York
Date Place Removed
g❑Removal and/or Held
t`= and/or Address
Hold
Date Point of
102❑Transportation Shipment
a by Common Destination
Carrier
❑Disinterment Date Cemetery Address
El Reinterment 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 or to Whom
Remains are Shipped, If Other than Above
Address
It
Permission is hereby granted to dispose of the human remains described above as indicated. ,
Date Issued 01/19/2018 Registrar of Vital Statistics WpdertA Curtis(E(ectronicafy 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:
Z
W Date of Disposition //21.1K Place of Disposition ; V-.0 /,,,, lo--
W (address)
ta
fg (section) (lot number) (grave number)
Qp Name of Sexton or Person in Charge of Premises. S"`^'�b
Z /�/ ( ease print)
W Signature �if'1 / Title (R1?�.�.
(over)
DOH-1555 (02/2004)