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Maers, James NEW YORK STATE DEPARTMENT OF HEALTH 1" 1 4 g 7Z- Vital Records Section Burial - Transit Permit Name First Middle Last Sex James Joseph Maers Male Date of Death Age If Veteran of U.S. Armed Forces, December 6, 2016 95 War or Dates LA.) .Y . Place of Death Hospital, Institution or Lit City, Town or Village Moreau Street Address 77 Lamplighter Acres Manner of Death Fri Natural Cause 0 Accident 0 Homicide 0 Suicide riUndetermined Pending tit Investigation .4 Medical Certifier Name Title Circumstances Robert P Reeves, Dr. Address Three Irongate Center Glens Falls, NY 12801 Death Certificate Filed District Number Register Number City, Town or Village Moreau y 5(0, A ❑Burial Date Cemetery or Crematory December 7, 2016 Pine View Crematory 0 Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed Removal and/or Held and/or Hold Address e'' rot Date Point of tti:El Transportation Shipment tom; by Common Destination 5 Carrier Disinterment Date Cemetery Address rt'0 Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078 Address 136 Main Street, South Glens Falls NY 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address L< Permission is hereby granted to dispose of the human remains described above as indicated. '" Date Issued /z j 7 h {0 Registrar of Vital Statistics i(Q,z..-0`114.1,- ,/2' O 1.- (signature) District Number (15 to - Place Tx/el c.X- 40jC a t1. • I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: k. Date of Disposition 12/07/2016 Place of Disposition Quaker Road Queensbury,NY 12804 (address) Ce (section) !4 (lot number (grave number) Name of Sexton or Person in Charge of remises L �raiff t'�`I6 (please print) Signature Title rim oliArg (over) DOH-1555 (02/2004)