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Smith, James NEW YORK STATE DEPARTMENT OF HEALTH •' 1► _ lir II 45 Vital Records Section Burial - Transit Permit Name First Middle ILast Sex James Clayton Smith Male Date of Death Age If Veteran of U.S. Armed Forces, i(�l"�'"� August 11, 2018 93 War or Dates 1"1t "J' \CAULO Place of Death Hospital, Institution or City, Town or Village Greenwich Street Address 835 County Route 52 Manner of Death rnli Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ ❑ Pending CircumstancesUndetermined Investigation Medical Certifier Name Title Address 3 C-( oe.i� S-f , M\ov-, . liti /Z°°K O Death Certificate Filed District Numb 5� Regis/Number City, Town or Village Greenwich ❑Burial Date 5 3zoio Cemetery or Crematory Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed ❑ Removal and/or Held and/or Address Hold Date Point of I Transportation Shipment by Common Destination Carrier ❑ Disinterment Date Cemetery Address ie ❑ Reinterment Date Cemetery Address Permit Issued to Registration Number y Name of Funeral Home M. B. Kilmer Funeral Home-Argyle 01077 a" Address 123 Main St., Argyle NY 12809 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued \ j 5 Registrar of Vital Statistics �7 C i&_e ) O -C ' Le..6 (signature) District Number S157 Place /O7,JYl Of' erczttt;)U-) - I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 7 Date of Disposition i J!c Its Place of Disposition Quaker Road Queensbury,NY 12804 (address) (section) (lot number) (grave number) Name of Sexton or Person in Charge of Pre ises I �i (please print) Signature ""^ Title MeAlva, (over) DOH-1555 (02/2004)