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Butler, James z .11 l i g NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section _a Burial - Transit Permit =--Name First Middle Last Sex , James Joseph Butler Male Date of Death Age If Veteran of U.S. Armed Forces, 10t10/2018 72 Years War or Dates 1964-1968 Place of Death Hospital, Institution or Az f� City, Town or Village Glens Falls Street Address Glens Falls Hospital fa Manner of Death®Natural Cause 0 Accident ❑Homicide Suicide Undetermined ri❑Pending Circumstances Investigation w Medical Certifier Name Title Jean Vanauken PA Address 100 Park St,Glens Falls,New York 12801 1 Death Certificate Filed District Number Register Number g.,; City, Town or Village Glens Falls 5601 481 O. ❑Burial Date Cemetery or Crematory 10/11/2018 Pine View Crematorium ©Entombment Address .``, V jCremation Queensbury Town, New York Date Place Removed zD Removal and/or Held and/or Address Hold 0 Date Point of 0 L. Transportation Shipment .5 by Common Destination Carrier Disinterment Date Cemetery Address :.-❑Reinterment Date Cemetery Address . i:, Permit Issued to Registration Number Number 1E..1Name of Funeral Home Carleton Funeral Home Inc 00281 ° Address 68 Main Sipo Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom k„ Remains are Shipped, If Other than Above Address 141 LL, Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/11/2018 Registrar of Vital Statistics Robert_4 CurtisiEaetrorie4/Ty Sijned) (signature) ` District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: LAAA Ill Date of Disposition /0 I 121t>3 Place of Disposition O—, '+_-.. (address) UJ CC (section) (lot number) (grave number) Q Name of Sexton or Person in Charge of Premises v fitL i ,S1dv Z (please print) Ui Signature A _ Title 01.04ft>I, (over) DOH-1555 (02/2004)