Carter, James Jay c
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records -
Name First Middle Last Sex
James Jay Carter Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/21/2023 79 Years War or Dates
Place of Death Hospital,Institution or
W• City,Town or Village Glens Falls Street Address Glens Falls Hospital
p• Manner of Death ❑X Natural Cause Accident ❑Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
G Scott Biasetti 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 44
Burial Date Cemetery,Crematory or Facility Name
01/24/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
DDonation
goRemoval Date Place Removed
and/or and/or Held
pN Hold Address
2
to❑Transportation Date Point of
Es by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
tpReinterment 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
p.. Remains are Shipped,If Other than Above
a Address
Jr
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/24/2023 Registrar of Vital Statistics Megan.No(n(Electronically 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:
Date of Disposition n21� 7 3 Place of Disposition -R.1L
W
2 (address)
W
Q (section) / (lot number) (grave number)
SName of Sexton or Person in Charge of P ises ` �a L5' 11
(please print)
UJ
W Signature Title ()ZAP')ii-Ve
DOH-1555(07/18)p 1 of 2
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#