McGowin, James -II 50
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section 1 Burial - Transit Permit
Name First Middle Last Sex
_'.;" James K. McGowin Male
ex-, Date of Death Age If Veteran of U.S. Armed Forces,
° `y January 12,2018 72 War or Dates Vietnam
:: Place of Death Hospital, Institution or
" , City, Town or Village Johnsburg Street Address 36 Oven Mountain Rd.
, : Manner of Death X Natural Cause Accident I j Homicide Suicide Undetermined Pending
° Circumstances Investigation
Medical Certifier Name Title
Ellen M.Duprey PA
Address
n;HHHN,North Creek,NY 12853
•:; Death Certificate Filed District Number Register,lyumber
:i City, Town or Village Johnsburg 5655
❑Burial Date Cemetery or Crematory
January 16,2018 Pine View Crematory
Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
th
O Date Point of
N Transportation Shipment
p by Common Destination
Carrier
n Disinterment Date Cemetery Address
n Renterment Date Cemetery Address
•.,- Permit Issued to Registration Number
:A, Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
°:° Remains are Shipped, If Other than Above
Address
b=:.:: Permission is he eby rante to dispose of the human rem ' s described above s indi ted.
t .:: Date Issued i / , gyp/ Registrar of Vital Statistics /pQ,vl (2._ //
„x.:a-: (signature
District Number 5655 Place Johnsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f
W Date of Disposition I//61ig Place of Disposition �..c ri,. �c.-.
W (address/
(I)
OC (saction) ,(dot number) r (grave number)
Op Name of Sexton or Person in Charge of Premises %°
Z (plea print)
Signature L Title fel irlut
(over)
DOH-1555 (02/2004)