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Parish, James Walter { • NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James Walter Parrish Male Date of Death Age If Veteran of U.S.Armed Forces, 02/01/2022 96 Years War or Dates unknown H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death O © Natural Cause EI Accident Homicide I=1 Suicide I=1 Undetermined El Pending W Circumstances Investigation V W Medical Certifier Name Title Q Gwendolyn Morris-Dickinson PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 82 ❑Burial Date Cemetery,Crematory or Facility Name 02/08/2022 Pine View Crematory Entombment Address lCremation Queensbury Town,New York Donation Removal Date Place Removed ▪ and/or and/or Held Hold Address 0 d Date Point of (r) Li Transportation ES Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above ▪ Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/07/2022 Registrar of Vital Statistics Megan Notin(ECectronicalfy 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: W Date of Disposition 01,11(-3k)2-3.. Place of Disposition ejrc., I/<. ' Gjt!h4'ltry 2 (address) N CC (section) (lot number) (grave number) el• Name of Sexton or Person in Charge of Premises ��'ri7!{IY Z (please print) W Signature Title DOH-1555(07/18)p t of 2 0 1 " J I 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#