Cashman, James NEW YORK STATE DEPARTMENT OF HEALTH * ..-.. `r`.3
Vital Records Section Burial :transit Permit
Name First Middle Last Sex
James Richard Cashman Male
Date of Death Age If Veteran ofiU.S. Armed Forces,
July 19,2015 73 War or Dates
#.► Place of Death Hospital, Institution or
Zs City, Town or Village Glens Falls Street Address Glens Falls Hospital
0: Manner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending
it Circumstances Investigation
ta Medical Certifier Name Title
0 Daniel Way
Address
HIHIN,North Creek,NY 12853
Death Certificate Filed District Number Registe Number
City, Town or Village Glens Falls 5601 I 352f—
❑Burial Date Cemetery or Crematory
ri
Entombment July 21,2015 Pine View Crematory
Address
❑X Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
O Date Point of
co Transportation 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
1.-° Remains are Shipped, If Other than Above
Address
w
Permission is hereb granted to dispose of the human r� ains described above as in'it.
Date Issued 07 / / Registrar of Vital Statistics / --,�.
( I n ure)
District Number 60/ Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition 71 alir Place of Disposition g ,.r ram`' '''
W (address)
U)
CL (section) (lot nur) (grave number)
pName of Sexton or Pers n in Charge of Premises €i
Z print)
W Signature 4SkTlease
Title tiViAtTitt)t-
(over)
DOH-1555 (02/2004)