Ganser, James Ernest ,
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records ,.°'
Name First M41le Last Sex
Y4 James Ernest Ganser Male
Date of Death Age If Veteran of US.Armed Forces,
t`: 01/29/2023 90 Years War or Dates Army
Place of Death Hospital,Institution or
City,Town or Village Moreau Town Street Address .198 Bluebird Road,Moreau Town,New York 12831
-; Manner of Death EINatural CauseAccident 0 Homicide E Suicide ❑Undetermined ❑Pending
Ti
Circumstances Investigation
Medical Certifier Name Title
Madison Zuis '' NP
Address '
,i 9 Carey Road,Queensbury Town,New York 12804
7s,, Death Certificate Filed District Number Register Number
t Town Of Moreau g
City,Town or Village `4562 5
Burial Date Cemetery,Crematory or Facility Name
01/31/2023 Pine View Crematory
Entombment Address
j EICremation Queensbury,New York
Donation
Removal Date Place Removed
and/or and/or Held
Hold Address
1 Date Point of
■Transportation Shipment
"6`'•., by Common
' Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
, Permit Issued to Registration Number
,, Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
r,,
Remains are Shipped,If Other than Above
Address
� Permission is hereby granted to dispose of the human remains described above as indicated.
ifd.`fg
Date Issued 01/31/2023 Registrar of Vital Statistics Leeann McCabe(ECectronicalrySigned)
(signature)
District Number 4562 Place Town Of Moreau
a I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 2 I Z I Z3 Place of Disposition (L • ,
W
2 (address)
iniU
It (section)Name of Sexton or Person in Charge of remises /A (lot number) (grave number)
/ 1. ^w1}t
( ase print)
W Signature Title rimM41-1-0�
DOH-1555(07/18)p 1 of 2
0 b
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#