Milne, James NEW YORK STATE DEPARTMENT OF HEALTH ° L J
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
James Warren Milne Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 30, 2013 78 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Argyle Street Address 1598 Hemlocks Lane
Manner of Death El Natural Cause 0 Accident 0 Homicide 0 Suicide 1-7 Undetermined Pending
Circumstances Investigation
L Medical Certifier Name Title
Gerald J. Hausler, D.O.
Address
8 Century Hill Drive Latham, NY 12110
Death Certificate Filed District Number h Register Number
City, Town or Village Argyle 6�� 15�
0 Burial Date Cemetery or Crematory
May 3, 2013 Pine View Crematory
❑Entombment
Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
El Removal and/or Held
and/or Address
Hold
0 Date Point of
ir,. n Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home 01077
Address
123 Main St., Argyle NY 12809
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
3.
Permission is here y granted to dispose of the human r ins described above as indicated.
Date Issued Q Registrar of Vital Statistics Ap
(signature)
District Number Sil As/PAPlace
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
: t A Date of Disposition 05/03/2013 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
i
(section) it (lot number) (grave number)
Name of Sexton or Perso in Charge o Premises psfc lr'" Senrk
( ease print)
Tr Signature Title C�k�vir� 0(�,
(over)
DOH-1555 (02/2004)