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Morehouse, James E. n NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Perms Bureau of Vital Records Name First Middle Last Sex James E.Morehouse Male Date of Death Age If Veteran of U.S.Armed Forces, 02/16/2021 67 Years War or Dates 1— Place of Death Hospital,Institution or WCity,Town or Village North Creek Hamlet Street Address 10 Pine Street, North Creek Hamlet, New York 12853 a Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending ILI Circumstances Investigation 0 Medical Certifier Name Title Ellen Deprey PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village North Creek . ► 5655 5 ❑Burial Date Cemetery,Crematory or Facility Name 02/18/2021 Pine View Crematory ❑Entombment Address O Cremation Queensbury Town,New York ❑Donation Z ❑Removal Date Place Removed and/or and/or Held F. N Hold Address 0 O. Date Point of ❑U) Transportation p by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above a Address EC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/17/2021 Registrar of Vital Statistics 2(cithfeen C.Lorafi(EfectronicaffySigned) (signature) District Number 5655 Place North Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 7111 Ili Place of Disposition F,4 A..— UJ 2 (address) W EC (section) (loot,ium r) (grave number) gName of Sexton or Person in Charge of Premises `'1 r \ I:NAAp Z (please prig) W Signature �� ZTitle (1140411ht DOH-1555(o7/18)p 1 of 2 1 Public Health Law Sec. 4145(2b) 0 1 4 5 5 fi Receipt Human remains of - _ delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# •