Lamkins, James Douglas It I.—)
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
James Douglas Lamkins Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/20/2021 61 Years War or Dates 1979-1983
H Place of Death Hospital,Institution or
WCity,Town or Village Milton Town Street Address 479 Rowland Street,Milton Town,New York 12020
`p Manner of Death I Natural Cause ❑Accident ElHomicide El Suicide LiUndetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
0 Aqeel Gillani MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Ballston Spa 4561 35
ElBurial Date Cemetery,Crematory or Facility Name
06/23/2021 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town,New York
❑Donation
zRemoval Date Place Removed
and/or and/or Held
N Hold Address
0
4. Date Point of
Cl) Transportation
El Common Shipment
Carrier Destination
Ei
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/22/2021 Registrar of Vital Statistics Brenda.7fowe(E/ctronicallj-I Signed
(signature)
District Number 4561 Place Ballston Spa, 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 �p�}'{/�':-) Place of Disposition Djr�V,r,� (if(, ar;Iy
2 I (address)
W
CC (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises Jzf�^taf J� �fe.S
Z (please print)
W Signature ode Title (,i
ft./Mole,(
DOH-1555(o7/t8)p t of 2
Public Health Law Sec. 4145(2b) 1 P
Receipt
Human remains of delivered on , 20,
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#