McRae, James Daniel Jr. •
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
James Daniel McRae Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/02/2022 68 Years War or Dates
F— Place of Death Hospital,Institution or
Z
City,Town or Village Moreau Town Street Address 18 Park Drive,Moreau Town, New York 12803
Manner of Death EI Natural Cause ❑Accident El Homicide Suicide nUndetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
O Robert Love MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed Town Of Moreau District Number Register Number
City,Town or Village 4562 57
Burial Date Cemetery,Crematory or Facility Name
11/04/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
O�Removal Date Place Removed
and/or and/or Held
H Hold Address
to
0
O. Date Point of
U)❑Transportation Shipment
by Common
Carrier Destination
Date Cemetery Address
Disinterment I
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
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 11/04/2022 Registrar of Vital Statistics Geeann McCabe(Electronically Signed)
(signature)
District Number 4562 Place Town Of Moreau
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition //-5 -Zj Z Z Place of Disposition yl ec i , j�n'iG�� irc f
2 (address)
W
Cr (section) ?number) (grave number)
SName of Sexton or Per in Charge of Premises v " 1 t�`t I e
Z / (please print)
W Signature /u//1 Title C rn4,- -y /A?
DOH-1555(o7/t8)p t of 2
f.. 1...6378
Public Health Law Sec. 4145(2b)
Receipt
Human remains of t delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# /1'„1