Daily, James P NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
James P Daily Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/19/2022 56 Years War or Dates
F Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address 214 Meadowbrook Drive E,Queensbury Town,New York 12804
p Manner of Death El Natural Cause Accident 0 Homicide 0Suicide Undetermined El Pending
W Circumstances Investigation
W Medical Certifier Name Title
C Howard Silverberg MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 56
Burial Date Cemetery,Crematory or Facility Name
e 03/21/2022 Pine View crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
H Hold Address
0
Date Point of
N Transportation Shipment
G by Common
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
a Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/21/2022 Registrar of Vital Statistics Caroline YfiiiIegarde Barber(c(ectronicaCCySigned)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
WDate of Disposition 3 Jrt I 2z Place of Disposition
2 (address)
W
N (section) of number) (grave number)
_
g Name of Sexton or Person in Charge of Premises z. r�' rt
(please int)
W Signature u( Title CM ron�
DOH-1555(07/t8)p t of 2
r7 159 6
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#