Hermance, James NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit permit
Name First Middle Last Sex
James E, Hermance male
Date of Death Age If Veteran of U.S. Armed Forces,
XXX
01 07 2000 52 War or Dates Vietnam
Place of Death Hospital, Institution or
)Qjq, Town amVWoigix Moreau Street Address 145 Gansevoort Road
Manner of Death FX�Natural Cause Accident Homicide 0 Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
John Rug e, MD
Address
Warrensburyg Health Center, Warrensbur , NY 12885
€ Death Certificate Filed District Number Register N ber
XXflljX Town X Moreau
Date Cemetery or Crematory
❑Burial 01/11/2000 Pine View Crematory
Address
0 Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
0❑Removal and/or Held
-- and/or Address
Hold
om Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01594
Address
53 Quaker Road, Queenbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued Registrar of Vital Statistics 1-64h
(signature)
District Number Jf�o Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f- , 11
W. Date of Disposition) Place of Disposition rN� f�I�N/ r,92"Ai 1f y
(address)
;w
>x (section) (lot u er) (grave number)
QName of Sexto or Person in Charge of Premises .��4j, /�2 � f �jlc/
z _ (please print)
Signature Title
(over)
DOH-1555 (9/98)
..._.,s
(--LF,„
Town of Queensbury
Certification of Cremation
� , Pine View Cemetery and Crematory
This certifies that the remains of: James Hermance
were cremated on January , 12 20 00 at the Pine View
(Month) (Day)
Crematorium, Queensbury,New York, and these are the cremated remains of said body.
Date of Death January 20 0o Age 82
(Month) (Day)
Funeral Home Regan Denny Funeral Home Registered No. 20
, ,.., V
(Authorized Signature)
PELKEY Lot No. 104
Address 3089 RT 9L, LAKE GEORGE NY 12845 ( Section No.
Owner THERESA & SHAWN PELKEY Plot ONEIDA
Date 1191..47__
APPROX . 33 Superficial ft. @
Location BOUNDED ON NORTH BY LYNCH, SOUTH BY PATH, EAST BY STEWART,
WEST BY PATCH .
Corner Posts
Remarks NOTE : RESERVED FOR SANDRA LEE HERMANCE
Deed No. ;arid changes) 3468
Payment Record PAID IN FULL 1/9/07 ( $550 . 00)
Record of Interments
.DP - -15. hod:
2 a, r4e-q° 4
•
, C. Ladd
C57:1
4 II
fi
�� la
Form No. 01
HERMANCE NAME James Heramance ( LF
' ' Age: 82
Lot Owner: Theresa & Shawn Pelkey
Lot# Oneida 1 0 4 Grave# 2
Case: Urn
Died: 1 .7.2 0 0 0 Interred: 9.1 5.2 3
Funeral Home: Regan Denny Stafford
Cemetery: Pine View