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Chenier, James Phillip 4_......F.)- �1 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit ermit Bureau of Vital Records Name First Middle Last Sex James Phillip Chenier Male Date of Death Age If Veteran of U.S.Armed Forces, 08/19/2022 67 Years War or Dates 1983-1988 f.. Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital UJ p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation GMedical Certifier Name Title Christopher Smith MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 436 Burial Date Cemetery,Crematory or Facility Name 08/24/2022 Pine View Crematory Entombment Address Cremation Queesnbury,New York Donation 0❑Removal Date Place Removed and/or and/or Held t- Hold Address N 0 o- Date Point of U) Transportation p by Common Shipment Carrier Destination o Disinterment Date Cemetery Address ElReinterment 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 F— Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/24/2022 Registrar of Vital Statistics Megan Nolin(E(ectronically Signed) (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: t— n I r`� Z Date of Disposition Y'?y zozzjlaceof Disposition }�t` tJ l/i eu) er 1 4- W (address) W Cr (section) (lot number) (grave number) SName of Sexton or Person in Charge f Premises —7ret y/M d a ci L,je Z (please print) • W Signature 41 Title © .(f'ov'i DOH-1555(07/18)p 1 of 2 b Public Health Law Sec. 4145(2b) 0 'b Receipt Human remains of delivered on , 20 Pine'View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#