White, James NEW YORK STATE DEPARTMENT OF HEALTH t ir•., 'J p3
Vital Records Section �.,n Burial - Transit Permit
Name First Middle Last Sex
James M. White Male
i Date of Death Age If Veteran of U.S. Armed Forces,
03 / 01 / 2016 59 War or Dates N/A
Place of Death Hospital, Institution or
ZCity, Town or Village Saratoga Springs Street Address Saratoga Hospital
0 Manner of Death El NaturalCause 0 Accident 0 Homicide E Suicide 0 Undetermined 7 Pending
Circumstances Investigation
in Medical Certifier Name Title
0 Carlos A Ares MD
Address
59 Myrtle St # 300, Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Number
City, Town or Village garatoga Springs
Jrurial Date Cemetery or Crematory
03 ,� 07 / "Al6
Entombment Pine View Crematory
Address =;;
Cremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
a.Q Transportation Shipment
by Common Destination
Carrier
''Q Disinterment Date Cemetery Address
Q Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
ii]ii Address
402 Maple Ave., Saratoga Springs, NY 12866
IiM
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
ir
Permission is er by granted to dispose of the human remains cribed above as indicated.
Date Issued s t IQ Registrar of Vital Statistics i Q_Z,,
-P: -4-Citten‘k
ipij (signature)
District Number 4 O. 1 Place Saratoga Springs , New York
'`" I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
111 Date of Disposition 3/$lit Place of Disposition ,�k,,V,,,., angfOrw.-
1 (address)
W.
Cr (section) (lot number) (' (grave number)
aName of Sexton or Person in Charge of Premises L�r�s� Jcvaltt�
Z (piese pent) •
Signature et 2i#11 Title OE MAW
(over)
DOH-1555 (02/2004)