Ries, James -w ? I/ SSd
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
James W. Ries Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 15, 2017 73 War or Dates National Guard
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
Ut
43. Manner of Death\( Natural Cause Accident El Homicide Suicide Undetermined Pending
11 r Circumstances Investigation
Medical Certifier Name ,, Title
Address ,.,r } / y OL, )s
Death Certificate Filed District Number 'Register y.�n er
City, Town or Village Glens Falls, NY
❑Burial Date Cemetery or Crematory
July 18, 2017 Pine View Crematorium
El Entombment Address
❑x Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
ZO ❑Removal and/or Held
and/or Address
H Hold
Cl)
O Date Point of
NTransportation Shipment
a 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
iNi Address
53 Quaker Road, Queensbury,NY 12804
gi 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 7) l 'l 1 ' Registrar of Vital Statistics vw
(signs re)
District Number 5 60 1 Place (3 S l\ ti Y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition y/S7 Place of Disposition ///)7t U.&J 2-/ ✓�,42 (address)
W
0 (section) / _ fiot number) (grave number)
QName of Sexton oro in Charge of Premises ,3Gt/►c•.rt C.,41- 4-vli.6-1—
Z (please print)
W
Signature Title .�,c m.h- ,—
(over)
DOH-1555(02/2004)