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Palmer, James a NEW YORK STATE DEPARTMENT OF HEALTH VitalRecords Section Burial - Transi t i ita ermit ,; Name First Middle Last I Sex s : James Lewis Palmer Male Date of Death Age If Veteran of U.S. Armed Forces, June 10, 2016 71 War or Dates Vietnam `tea Place of Death Hospital, Institution or _City, Town or Village Glens Falls Street Address Glens Falls Hospital :fa111. Manner of Death Natural Cause 0 Accident ❑ Homicide El Suicide ❑ Undetermined ❑ Pending zt- Circumstances Investigation 111e Medical Certifier Name Title Address M �▪ � Death Certificate Filed District Number ��1 �� Registy�n City, Town or Village (( ❑Burial Date Cemetery or Crematory June 13, 2016 Pine View Crematorium . ❑Entombment Address n©Cremation Quaker Road Queensbury,NY 12804 ;,, Date Place Removed 70• ❑ Removal and/or Held and/or Address • Hold Date Point of a. 0 Transportation Shipment • by Common Destination ,C) Carrier ❑ Disinterment Date Cemetery Address ▪ ❑ Reinterment Date Cemetery Address ? Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom 'I- Remains are Shipped, If Other than Above 4 Address CC IliaQ. Permission is hereby granted to dispose of the human remains descri v s i 3,1J . Date Issued �o' 2©l6 Registrar of Vital Statistics 0 ,,, .„.., (signature) District Number C�60/ Place ��� Aih, N.Y. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Et Date of Disposition 06/13/2016 Place of Disposition Quaker Road Queensbury,NY 12804 21 (address) 11.11It, (section) / (lot number) cc (grave number) fa Name of Sexton or Person in Charge of Premises Ls�nr J th„��- z, please print) `LU Signature Title LfO7Jl (over) DOH-1555 (02/2004)