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LaDuke, James C � i NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James C.LaDuke Male Date of Death Age If Veteran of U.S.Armed Forces, 08/20/2021 79 Years War or Dates 1—. Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death © Natural Cause ❑Accident IDHomicide El Suicide El Undetermined ❑Pending Circumstances Investigation W• Medical Certifier Name Title CI Sean Bain MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 346 ❑Burial Date Cemetery,Crematory or Facility Name 08/20/2021 Pine View Crematory ❑Entombment Address Cremation Queensbury Town,Warren,New York ❑Donation • Removal Date Place Removed and/or and/or Held - Hold Address 0 d Date Point of co Li Transportation p by Common Shipment Carrier Destination Date Cemetery Address Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 01199 Address 6357 Nys Rte#30, Indian.Lake,New York 12842 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above a Address CC W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/20/2021 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (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: I- � Z Date of Disposition � (Q )..( Place of Disposition a9;tie():U',' Cal 2 (address) LU CC CC (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises �1����r� Z (plea print) W Signature c_ Title or u DOH-1555(07/i8)p t of 2 Public Health Law Sec. 4145(2b) .1.5059 Receipt Human remains of z- delivered on ' '' , 20 c Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# •-'