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McCarty, James „i! • e NEW YORK STATE DEPARTMENT OF HEALTH i4 Z? Vital Records Section Burial - Transit' Permit Name First Middle Last Sex James J. McCarty Male Date of Death Age If Veteran of U.S. Armed Forces, April 9, 2015 76 War or Dates : Place of Death Hospital, Institution irondack Tri-County Health Care City, Town or Village Johnsburg Street Address Center a° Manner of Death Undetermined Pending Natural Cause Accident Homicide Suicide Circumstances Investigation ui Medical Certifier Name Title a James Hindson Dr. Address Main St.,Warrensburg,NY 12885 Death Certificate Filed District Number Register Number City, Town or Village Johnsburg 5(p 5- % / ❑Burial Date Cemetery or Crematory Ill Entombment April 10,2015 Pine View Crematory Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z I !Removal and/or Held and/or Address H Hold N O Date Point of NTransportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander-Baker Funeral Home 00037 Address 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom > Remains are Shipped, If Other than Above S. Address re la- Permission is hereby granted to dispose of the hum remains described ab ve as indicated. Date Issued �/9/v9 C>1 J Registrar of Vital Statistic ,-----,A 0e.—p (signature) District Number f;(p j Place Johnsburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Place of Disposition -7?�1� C,, w Date of Disposition 4I i 31g� p 2 (address) W cn re (section) (lot numl ) (grave number) Q Name of Sexton or Person in Charge of Premises g � Je.4•. f Z (please print) w Signature it Title 12 (over) DOH-1555 (02/2004)