Greene, Sr. James NEW YORK STATE DEPARTMENT OF HEALTH P ~ Z�
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
James William Greene Sr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
4.01 March 24, 2018 60 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Moreau Street Address 10 Jon Kay Road
et Manner of Death ux_ Natural Cause ❑ Accident ❑ Homicide 0 Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
In Medical Certifier Name Title
Igbal Bashir, M.D
Address
6 Hearts Way Queensbury, NY 12804
Death fear icate Filed District (� Register Number
City own a Village l�2,,cc � l �— 'IL!
0 Burial Date Cemetery or Crematory
March 30, 2018 Pine View Crematorium
❑Entombment Address
-:' ®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
. ❑ Removal
and/or and/or Held
' Hold Address
4
` Date Point of
`, q ❑Transportation Shipment
by Common Destination
Carrier
� Disinterment Date Cemetery Address
❑ Reinterment Date Cemetery Address
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
I Remains are Shipped, If Other than Above
Address
," Permission is hereby ranted to dispose of the human remains de ribe b e as indicated.
Date Issued 3 /3 Registrar of Vital Statist s
(sig ature)) �/
District Number Place E 3 ( e ,'?u 1/C_,/S / q g"'f. /,) eo
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 03/30/2018 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
,i
101
r (section) /r (lot number) (grave number)
cc Name of Sexton or Person in Charge f Premises
`L S
( lease print)
Signature d Title ai°"n pa,
(over)DOH-1555 (02/2004)