Ware Sr, James NEW YORK STATE DEPARTMENT OF HEALTH e • 4 M.
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
James W.Ware Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
12/17/2017 79 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X❑ Natural Cause ❑Accident ❑Homicide ❑Suicide ❑ Undetermined El Pending
Circumstances Investigation
Medical Certifier Name Title
Jean Vanauken PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 644
El Burial Date Cemetery or Crematory
12/19/2017 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York
Date Place Removed
ri❑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 Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
. 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 12/18/2017 Registrar of Vital Statistics W6ertACurtis 'ECectronicaaySigned
(signature)
District Number 5601 Place Glens Falls, New York
:yam
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition iZj to in Place of Disposition firg.V, ey,eir—
(address)
Z. (section) nu
Name of Sexton or Person in Charge of P ises � (lot ber (grave�, sn l' number)please print)
Signature 4 .F Title MVO/
(over)
DOH-1555 (02/2004)