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Ricker, James Francis NEW YORK STATE DEPARTMENT OF HEALTH r- Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James Francis Ricker Male Date of Death Age If Veteran of U.S.Armed Forces, 07/30/2021 45 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 66 Bay Parkway,Queensbury Town, New York 12804 LU p Manner of Death ©Natural Cause D Accident p Homicide ❑Suicide ❑Undetermined ❑Pending W Circumstances Investigation GMedical Certifier Name Title Timothy Murphy Coroner Address 52 Haviland Avenue,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 157 ▪Burial Date Cemetery,Crematory or Facility Name 08/02/2021 Pine View Crematory Entombment Address lCremation Queensbury Town,New York ▪Donation OZ Removal Date Place Removed and/or and/or Held N Hold Address O O. Date Point of co ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address 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 1— Remains are Shipped,If Other than Above '"S Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/02/2021 Registrar of Vital Statistics Caroline x&legarde(Barber(E(ectronwalty 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: Z IL Date of Disposition Si 13 I24 Place of Disposition (tic(`,,, (address) W Q (section) (lot numbe (grave number) SName of Sexton or Person in Charge of Premises , G A e ittA—. + 1 Z (please print) W Signature Title r DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 9 14995 Receipt Human remains of - delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#