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Porter, James : t NEW YORK STATE DEPARTMENT OF HEA r1 Vital Records Section Burial - Transit Perri* Name First Middle Last Sex James Francis Porter Male Date of Death Age If V -ran of U.S. Armed Forces, 09/30/2018 79 Years War or Dates 1962 Place of Death Hospital, Institution or City, Town or Village Schenectady Street Address Ellis Hospital Manner of Death©Natural Cause [D Accident Homicide CJ Suicide 0 Undetermined ri Pending Circumstances Investigation Medical Certifier Name Title Miroslav Vytrisal MD Address 1101 Nott St,Schenectady,New York 12308 Death Certificate Filed District Number Register Number City, Town or Village Schenectady 4601 846 DBurial Date Cemetery or Crematory 10/01/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed 1-1 Removal and/or Held and/or Address Hold Date Point of []Transportation Shipment by Common Destination Carrier Date Cemetery Address �;❑Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 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 10/01/2018 Registrar of Vital Statistics Cfiarles`Gt/ilfiam gnome((tectmnicat(y Signed) (signature) District Number Place 4601 Schenectady, New York �53 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition /o1311% Place of Disposition go,L (address) (section) (lot!'umber) (grave number) Name of Sexton or Person in Charge of Premises (fir �,c SoAk4Ld. (please print) Signature ` Title frtf FA4- (over) DOH-1555(02/2004)