Young, James NEW YORK STATE DEPARTMENT OF HEALTH £ x t LL5
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
James P Young Male
Date of Death Age If Veteran of U.S.Armed Forces,
I. April 8, 2013 65 War or Dates no
Z Place of Death Hospital, Institution or
W City,Town, or Village Whitehall Street Address Home
G Manner of Death Natural Cause 0 Accident El Homicide OSuicide 0 Undetermined 0 Pending
W Circumstances Investigation
0 Medical Certifier Name Title
W Dr. Julie Foster, M.D. Dr.
0 Address
275 Route 30N, Bomoseen, VT 05732
Death Certificate Filed District NumberRegister Number
City,Town or Village Whitehall 6 3
❑Burial Date Cemetery or Crematory
April 15, 2013 Pineview Crematorium
❑Entombment Address
n Cremation Quaker Road Queensbury, NY 12804
Date Place Removed
4 0 Removal and/or Held
- and/or Address
1' Hold
0 Date Point of
0EI Transportation Shipment
D. by Common Destination
Carrier
Date Cemetery Address
5 0 Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
t= Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped, If Other than Above
a
W Address
0.
Permission is here y granted to dispose of the hum ains describ- • above as indicated.
Date Issued 4 a. Za/3 Registrar of Vital Statistic 5- ,
(•nature)
District Number .517563 Place rk `-I 4-Y4-1117 ql Aktd yew L
H I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 04/15/2013 Place of Disposition Pineview Crematorium
2 (address)
W
v)
0 (section) 4(lot number) C (grave number)
CIName of Sexton or Person in Charge of Premises n& itAitt
W (pl ase print)
Signature 4 -Y1—_ -_ Title ( gtrl 2
(over)
DOH-1555 (02/2004)