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Hamm, James H. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James H Hamm Male Date of Death Age If Veteran of U.S.Armed Forces, 12/11/2020 71 Years War or Dates .._ Place of Death Hospital,Institution or W City,Town or Village Saratoga Springs Street Address Saratoga Hospital 1p Manner of Death © Natural Cause ❑Accident El Homicide Suicide ❑Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title O Maria Vivenzio DO Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 644 ElBurial Date Cemetery,Crematory or Facility Name 12/14/2020 Pineview Crematory ElEntombment Address iCremation Queensbury Town,New York ElDonation ZEl Removal Date Place Removed and/or and/or Held ~ N Hold Address O Date Point of N Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above a Address 2 W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/14/2020 Registrar of Vital Statistics John Paul Franck(Electronically Signed) (signature) District Number 4501 Place Saratoga Springs, 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 12.11117o Place of Disposition W 2 (address) CU CC N (sedan) /I(tot number) _ (grave number) alName of Sexton or Person in Charge of P ises ��n�� Z (p/eas4print) W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 01 4 24,8 Receipt Human remains of delivered on = , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#