Kneeshaw, James Thomas �---- s
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NEW YORKSTATE DEPARTMENT OF HEALTH t \ ! l _ 1
Bureau of Vital Records , Burial Transit Permit
Name First Middle Last Sex
James Thomas Kneeshaw Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/17/2022 87 Years War or Dates 1957-1962
H Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 11 Pioneer Point,Queensbury Town, New York 12804
p Manner of Death 7 Natural Cause Accident1=1 Homicide Suicide Undetermined ❑Pending
1 Circumstances Investigation
W Medical Certifier Name Title
O David Cunningham MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 192
Burial Date Cemetery,Crematory or Facility Name
12/20/2022 Pine View Cemetery and Crematory
Entombment Address
iiCremation Queensbury Town,New York
Donation
ZO Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
0
O. Date Point of
(/)EiTransportation
p by Common Shipment
Carrier Destination
O
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
1— Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/20/2022 Registrar of Vital Statistics Carolinexkligari Barb-er(Electronicall'Sign d)
(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:
H <
Z Date of Disposition /z—ZZ-'zcz2Z Place of Disposition �:,�L �)„e,,,.i ('fern c rN
uJ (address)J
2
W
NCC (section) (lot nu ber) (grave number)
GName of Sexton or Person in Charge of P ses �< �Y��IP�✓� hi°o cl
Z (please print)
W Signature ,�-r 1 Title t1,�' T�i.
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