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Nobile, James R
. . . J1y2 NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James R Nobile Male Date of Death Age If Veteran of U.S.Armed Forces, 08/04/2021 93 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc p Manner of Death © Natural Cause ❑Accident El Homicide ❑Suicide El UndeterminedEl Pending w Circumstances Investigation W Medical Certifier Name Title G Jennifer Denis NP Address 131 Lawrence St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 423 0 Burial Date Cemetery,Crematory or Facility Name 08/06/2021 Pine View Crematory ❑Entombment Address lCremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held N Hold Address O O. Date Point of co ❑Transportation Shipment B by Common Carrier Destination El Disinterment Date Cemetery Address Date Cemetery Address Reinterment 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 1— Remains are Shipped,If Other than Above 2 Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/06/2021 Registrar of Vital Statistics John Tau(Franck(ECectronicaltySigned) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition 4 Il I14 Place of Disposition tic`I� O6, 2 address/ W (section) (tot number)so4 (grave number) Name of Sexton or Person in Charge of Premises �fi1 L �' (pie.*print) ,� Signature Title YG�Mw ''C DOH-1555(07/18)p 1 of 2 1, 5C )7 1 Public Health Law Sec. 4145(2b) Receipt P 1 IHuman remains of -,c C'''�(i'',s )Q- delivered on , 20 1 y ,' /,Y Pine View Cemetery Representing the funeral home named o,n burial permit Official Funeral Directors Reg.or License# ( I '