Hilton, James NEW YORK STATE DEPARTMENT OF HEALTH f S81
Vital Records Section Burial - Transit Permit
Name First Middle - Last Sex
James Fred Hilton Male
Date of Death Age If Veteran of U.S. Armed Forces,
8/8/2015 81 War or Dates No
Place of Death Hospital, Institution or N
City, Town or Village Fort Edwzrd ''- . ..
StreetAddress 574 County Rt. 46, Fort Edwar
a Manner of Death®Natural Cause ElAccident ElHomicide ElSuicide ❑Undetermined ❑Pending
lE Circumstances Investigation
tu Medical Certifier Name Title
John P. Stoutenberg MD
Address
• 102 Park street, Glens Falls NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Fort Edward 5755
igi El Burial Date Cemetery or Crematory
8/11 /15 Pine View Crematory
M['Entombment Address
iE OCremation Queensbury, NY 1 2804
Date Place Removed
Z❑Removal and/or Held
and/or Address
f=` Hold
0 Date Point of
will❑Transportation Shipment
a by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
3' Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01 079
Address
> 82 Broadway, Fort Edward, NY 12828
el Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
,'" Address
lL
Permission is hereby granted to dispose of the human re 'ns described above as'ndicated.
4
Date Issued 8/1 0/201 5 Registrar of Vital Statistics -~-
`-------
/ (signat
ure)
District Number 5755 Place , 1� i-- �Fxif
,o
1„,,,,,:,,,:i!; I certify that the remains of the decedent identified ve were disposed of in accordance with this permit on:
2
ILI Date of Disposition Si itji c Place of Disposition Ris.✓ et4 ;,.,.,
(address)
ILI
CO
CC (section) (lot number) (grave number)
Name of Sexton or Person in Charge,of Premises 3
z bit() (piea�e print)
114 Signature Title areri Mit
(over)
DOH-1555 (02/2004)