Hughes, James NEW YORK STATE DEPARTMENT OF HEALTH' 1 'i -7K7
Vital Records Section Burial - Transit Permit
—
* Name First Middle Last Sex
James William Hughes Male
Date of Death Age If Veteran of U.S. Armed Forces,
September 28, 2018 44 War or Dates
Place of Death Hospital, Institution or
1SS:
City, Town or Village Hudson Falls Street Address 14 Walnut Street
Manner of Death 0 Natural Cause 0 Accident Ej Homicide 0 Suicide n Undetermined Pending
ILI
0— Circumstances Investigation
aMedical Certifier Name Title
Charles Yun, MD
Address
4 102 Park Street Glens Falls, NY 12801
Death Certificate Filed District Number Register number
City, Town or Village ,s5-7.6 I
- 0 Burial Date Cemetery or Crematory
Pine View Crematorium
0 Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
t 0 Removal and/or Held
and/or Address
Hold Pine View Crematorium
= Date Point of
�>❑Transportation ' - Shipment
tti'.. by Common Destination
C1, Carrier
0 Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
14; , Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
l- _ Remains are Shipped, If Other than Above
, Address
W
tl.; Permission is hereby granted to dispose of the human rmai described above as indicated.
Date Issued / / Registrar �of Vital Statistics ��" � 4 �,�e�-e.<-.-
lO
(signature)
oii District Number _5-7ai Place (..3 Cl - ,. +, 03--,--;
irr I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F
ILL Date of Disposition /e it (I$ Place of Disposition Quaker Road Queensbury,NY 12804
2 (address)
At-7, (section) (lot number) (grave number)
0
S
Name of Sexton or Person in Charge of Premises d�•,twr L.)A pt
Z ,j (p/ ase print)
LU Signature G✓/ "tr Title f I ��r�llt%
(over)
DOH-1555 (02/2004)