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Hunt. James William r . ttt '/37 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James William Hunt Male Date of Death Age If Veteran of U.S.Armed Forces, 05/19/2021 68 Years War or Dates 1975-1980 i_ Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 12 Gentry Lane,Queensbury Town,New York 12804 p▪ Manner of Death ©Natural Cause ❑Accident ❑Homicide El Suicide DUndetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title a Joseph Mihindukulasuriya MD Address 20 Murray Street,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 108 Burial Date Cemetery,Crematory or Facility Name 05/21/2021 Pine View Crematorium ❑Entombment Address lCremation Queensbury Town,New York ❑Donation IS ❑Removal Date Place Removed and/or and/or Held f- Hold Address 0 G. Date Point of (I) ❑Transportation Shipment p by Common Carrier Destination Date Cemetery Address ❑Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/20/2021 Registrar of Vital Statistics Caroline 2fi(degarde Barber(E(ectronica((y Signed) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: �J Z Date of Disposition 51 it 174 Place of Disposition 60..... �../T......... ILI 2 (address) W CC CC (section) d(lot number) (grave number) S Name of Sexton or Person in Charge of Pr isesa ti 41( /p(easf print/ W g rs Si nature Title c ` CW DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) U 1 8 E 7 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#