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Hall, James W /Dqe NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital.Records Name First Middle Last Sex James W.Hall Male Date of Death Age If Veteran of U.S.Armed Forces, 12/19/2021 61 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital pManner of Death © Natural Cause EjAccident E Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title Dean Reali DO Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 747 ElBurial Date Cemetery,Crematory or Facility Name 12/21/2021 Pine View Crematorium ❑Entombment Address 0 Cremation Queensbury Town,New York ElDonation Q Removal Date Place Removed and/or and/or Held F- Hold Address O C. Date Point of V) j Transportation Shipment by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc ':. 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls, New York 12839 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,1f Other than Above 2 Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/20/2021 Registrar of Vital Statistics John Paul Franck(Electronically Signed) (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: IH Z Date of Disposition /� /-Z-o2( Place of Disposition f Ale 1,/,'e„� Ct-eyn 4- ,r (address) W cC (section) (lot numb r) (grave number/ 8 Name of Sexton or Person in Charge o remises 'f, 7'1 b �Jo please print) // �-- W Signature ja- l' Title C1 DOH-1555(07/18)pi of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of '' delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#