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Bell, James B nrzt1 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James B Bell Male Date of Death Age If Veteran of U.S.Armed Forces, 11/25/2020 95 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation p Manner of Death © El Undetermined ❑Pending 11.1 Natural Cause 1:1Accident Homicide Suicide V Circumstances Investigation W Medical Certifier Name Title CI Jean Flanagan MD Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 533 ❑Burial Date Cemetery,Crematory or Facility Name 11/28/2020 Pine View Crematory ❑Entombment Address ICremation Queensbury Town,New York ❑Donation 4 Removal Date Place Removed and/or and/or Held N Hold Address 0 d Date Point of ❑ Cl) Transportation by Common Shipment Carrier Destination Date Cemetery Address El Disinterment Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address CC LU a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/27/2020 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: � Z Date of Disposition /A,78 leto Place of Disposition U i,tee (?: W (address) W CC (section) (lot number) (grave number) '/ Name of Sexton or Person in Char e of Pr ises J��T`nt,,i c"J E. cd A' (please print) W Signature f 4/7/ Title o�e�ti S DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) J . Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#