Donohue, James NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
James George Donohue Male
Date of Death Age If Veteran of U.S. Armed Forces,
04/12/2018 69 Years War or Dates Air Force
Place of Death Hospital, Institution or
City, Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare
Manner of Death J Natural Cause ❑Accident ❑Homicide ❑Suicide Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Jennifer Hayes MD
Address
4573 State Route 40,Argyle Town,New York 12809
Death Certificate Filed District Number Register Number
City, Town or Village Argyle 5750 8
❑Burial Date Cemetery or Crematory
04/16/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,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 04/13/2018 Registrar of Vital Statistics ShelleyfMckernon(ECectronicafySigned)
(signature)
District Number 5750 Place Argyle, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition q/6 IN Place of Disposition
(address)
(section) r(lot numbs) (grave number)
Name of Sexton or Person in Charge of Premises
(phase print)
Signature ( Title (R f
(over)
DOH-1555(02/2004)