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Ludwig Sr., James v NEW YORK STATE DEPARTMENT OF H .'LT- ' 11 - Vital Records Section Burial - Transit Permit = Name First le Last Sex James Ludwig,Sr. Male = Date of Death e If Veteran of U.S. Armed Forces, r«a December 30,2018 87 War or Dates a<x=° Place of Death Hospital, Institution or City, Town or Village Diamond Point Street Address 55 The Back Road a; Manner of Death X Natural Cause Accident Homicide I 1 Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title Mark M.Hoffman Address n 102 Park St.,Glens Falls,NY 12801 ; Death Certificate Filed District Number Register Number .;] City, Town or Village 5650 I ❑Burial Date Cemetery or Crematory ❑ January 2,2019 Pine View Crematory Entombment Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z I 'Removal and/or Held and/or Address H Hold Cl) 0 Date Point of N I 1 Transportation Shipment p by Common Destination _ Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address ' Permit Issued to Registration Number _, :Z:,:' 00037 Name of Funeral Home Alexander-Baker Funeral Home Address 3809 Main Street,Warrensburg,NY 12885 xw;'. 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 l-2- 2.O\\ Registrar of Vital Statistics >tkft_.3_(signature) District Number skt. 7 Place '-- 03\ (1 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z w Date of Disposition 1/3 ` 15 Place of Disposition get,....- es►'r0fly_ E (address) W cn CL (section) /A (ot number (grave number) a Name of Sexton or Person in Charge of P emises Ii r+� Gw^IIr( Z (ple se print) W 0 Signature Title f1Z¢=stattpt (over) DOH-1555(02/2004)