Eggleston Jr., James E. 3�
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
James E.Eggleston Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/03/2021 52 Years War or Dates
�.., Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address 274 Warren Street 1,Glens Falls,New York 12801
'p Manner of Death ❑Natural Cause ❑Accident El Homicide Suicide ❑Undetermined ❑X Pending
V Circumstances Investigation
OMedical Certifier Name Title
Timothy Murphy Coroner
Address
52 Haviland Avenue,Glens Falls,New York 12801
Death Certificate Filed District Number Register Numb
City,Town or Village Glens Falls 5601 167
Burial Date Cemetery,Crematory or Facility Name
04/07/2021 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town,New York
Donation
g0 Removal Date Place Removed
and/or and/or Held
Hold Address
N
0
O. Date Point of
❑Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Other than Above
2 Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/06/2021 Registrar of Vital Statistics iep6ertAnrlrewCurtir(E/ectronicai 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:
W Date of Disposition 1-j^7-7I Place of Disposition Ld(��
2 (address)
Lu
N
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises �� t.t 1-p1—,_)AAA'fif
Z (ples'print)
W Signature 21'
Title LrIX r''v}jf
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b) 01'46 9 9
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#