VanVranken, James Jay State of Florida, Department of Health, Bureau of Vital Statistics
PP"�.'"j'EE BURIAL TRANSIT PERMIT
tHEALTH DATE PRINTED:June 3,2022 TRACKING NUMBER: 2022108449
1. DECEDENT INFORMATION
Name of Deceased Date of Death
JAMES JAY VANVRANKEN June 3,2022
Place of Death-County City,Town or Location Name of facility,or street address if not a facility
PINELLAS DUNEDIN 870 PATRICIA AVENUE
Name and Address of Funeral Home/Direct Disposal Establishment Fla.Lic.No./Reg.No. Phone Number
HOLLOWAY FUNERAL HOME INC F080152 F080152 (813)855-2439
112 BAYVIEW BLVD
OLDSMAR,FLORIDA,34677
Funeral Director/Direct Disposer Fla.Lic.No./Reg.No.
HALLIE A.SHOEMAN F045261
Medical Verification Statement
DR LEVINE at the certifying physician's office,was contacted on 06/03/2022 by the funeral director listed above;he/she indicated
that LARRY R LEVINE,certifying physician,will complete and sign the medical certification of cause of death within 72 hours.
2. BURIAL -TRANSIT PERMIT
The Florida Department of Health, Bureau of Vital Statistics
hereby grants permission to dispose of this body in accordance with Chapter 382, Florida Statutes.
Permit Number: 2022-F080152-5676
Date Issued: June 3,2022
State Registrar
3. AUTHORIZATION for CREMATION, DISSECTION, BURIAL-AT-SEA, or HOSPITAL DISPOSITION
Authorization given by Medical Examiner District Approval Number:
4. CEMETERY OR CREMATORY
Place of Disposition: Pine View Cemetery, Queensbury, NY
Method of Disposition: REMOVAL FROM STATE Date of Disposition: June 8, 2022
EDRS maintains all statutorily required information regarding the death record and related
burial transit permit, therefore, returning the permit to the county health department is no
longer required.
If the Place of Final Disposition wishes to retain the copy of the permit for their file they may do so.
DH 326E,10/12
64V-1 011,Florida Administrative Code
Public Health Law Sec. 4145(2b)
012923
Receipt
Human remains of `, delivered on , 20
Ri a View Cemetery Representing the funeral home named on burial permit
, fficial Funeral Directors Reg.or License#
VAN VRANKEN Lot No. 1-B
Address 220 Main St. , So . Glens Falls, N.Y. Section No.
Owner Walter Van Vranken Plot New Kenesaw
Date 11/15/58
Approx. 100 Superficial ft. @ $1.30 per sq. ft = $130.00
Location Bounded on s/w by Chepontuc Ave.
Corner Posts
Remarks
Deed No. (and changes) 728
Payment Record Paid in full 11/15/58
Form No. 01
Record of Interments
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NAME James Jay Van Vranken Age:
Lot Owner: Walter VanVranken
Lot# New Kenesaw 1 B Grave# 1
Case: Concrete
Died: 6.3.2 2 Interred: 6.8.2 2
Funeral Home: Holloway Funeral Home
Cemetery: Pine View