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O'Connell, James J
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle .,,> Last Sex James J.O'Connell Male Date of Death Age If Veteran of U.S.Armed Forces, 07/18/2021 69 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause 0 Accident El Homicide El Suicide ❑Undetermined ri Pending W Circumstances Investigation WMedical Certifier Name Title 0 Marvin Davidowitz MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 298 ❑Burial Date Cemetery,Crematory or Facility Name 07/21/2021 Pine View Crematory ElEntombment Address Cremation Queensbury Town,New York 0 Donation 6 ❑Removal Date Place Removed and/or and/or Held H Hold Address N IL Date Point of (/) ❑Transportation' Shipment p by Common — Carrier Destination 0 Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 2 Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/20/2021 Registrar of Vital Statistics cR96ertAncirew Curtis(ECectronicallySigned) (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: Z Date of Disposition 7/Z j I II Place of Disposition 17...1.Vt... ( +iof.—• 2. (address) Ui Ct (section) (lot number) (grave number) Name of Sexton or Person in Charge Af remises A -)P.trt Z // i�`.. /ple a print) W twit Signature Title (arm DOH-1555(07/18)p i of 2 Public Health Law Sec. 4145(2b) - = Receipt Human remains of delivered on , 20 f j Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# •