Yole Jr, James NEW YORK STATE DEPARTMENT OF HEALTH ` -' If Zr
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
James Beeecher Yole Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 10, 2015 54 War or Dates
F- Place Bath Hospital, Institution or
WCity own_ r Village Kingsbury Street Address 78 Mountainview Drive
0 Manner of Death LJ Natural Cause ❑ Accident ❑Homicide 0 Suicide El Undetermined ❑ Pending
,, Circumstances Investigation
W Medical Certifier Name Title
Eric Pillemer, M.D. Dr.
Address
102 Park Street Glens Falls, NY 12801
Y Death Certificate Filed District Number Register Number
City, Town or Village 576 o a
❑Burial Date Cemetery or Crematory
January 12, 2015 Pine View Crematorium
❑Entombment Address
LMCremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
and/or Address
E Hold
U)' Date Point of
❑Transportation Shipment
CO by Common Destination
Ci Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
y El Reinterment
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
2 Address
IX
2 Permission is hereby granted to dispose of the human remain described above as indicated.
- Date Issued Q`-1 - aJIS_ Registrar of Vital Statistics � n ,—
(signature)
•
District Number 5-'76 J., Place owe 0.4 ,, o S(
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
II--
-E-- Date of Disposition 01/12/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
W';
(section) of number) (grave number)
a' ('
Name of Sexton or Person incharge of Premises rs r .�1erl*
(pledse print)
W Signature I t�—�• Title rn ►mArtie,
(over)
DOH-1555 (02/2004)