Turner, James .. • , 41 Ltir.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
ir-,,•,: Name First Middle Last Sex Male
0*,
:n::i James W. Turner
Date of Death 1 A,9e If Veteran of U.S. Armed Forces,
41 9/24/2011 i 83 War or Dates No
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Place of Death
OW TownMODUC( Johnsburg
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• Medical Certifier
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I Hospital, Institution or
Street Address Adk. Tri County N.H.
Manner of Death
NaNtaumraleCanuse [--_i Accident 0 Homicide 0 Suicide
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cL-1( MN Title Undetermined r-I Pending
Circumstances"-I "-I Investigation
_-Add ess 1
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W.,
w, Death Ceacate Filed District Number Register Numper
i,:g MC Town •••1).q.-111:Johnsburg 6/0(55- 3b
Date Cemetery or Crematory
::.. El Burial 9/27/2011 Pine View Crematory
Address
. 123 Cremation Queensbury,NY
Z Date Place Removed
0 r--I Removal I and/or Held
and/or I—J
P I Address
a Hold i
0 Date J Point of
0 Transportation Shipment
0 by Common Destination
Carrier
Date Cemetery Address
Disinterment
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0 Reinterment Date Cemetery Address
Permit Issued to i Registration Number
;•'4, Name of-Funeral Home Miller Funeral Home 1 01199
Address
6357,State Route 30, Indian Lake,NY 12842
V Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Igo
Permission is_h rob granted ranted to dispose of the human rem 'ns described twit; as indicated.
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Date Issued 9 & 1 Registrar of Vital Statistics ' _-'1:s ecat,- -
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(signature)
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District Number 66.sr Place JO(4.)/1 O' jAjti h
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.:::. I certify that the remains of the decedent identified above were disposW-din accordance with this permit on:
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Date of Disposition clItillA Place of Disposition Plot litua Cen..-ci or
(address)
co
(section) /7 (lot umber) c- (grave number)
g Name of Sexton or Person,p)Charge of Pr ises t, it,$A f-• --- PA-cii-
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4! Signature g41\w' (please print)Title MC(III icaoit.
DOH-1555 (10/89) p. 1 of 2 VS-61