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Freeman, James Hall NEW YORK STATE DEPARTMENT O L'�� F HEALTH Burial - Transit Permit Bureau of Vital Records Na `Fast Middle Last Sex J Hall Freeman Male ! d` of Death Age If Veteran of U.S.Armed Forces, /05/2023 74 Years War or Dates F Place of Death Hospital,Institution or ILI Z City,Town or Village Edinburg Town Street Address 1298 South Shore Road, Edinburg Town, New York 12835 p Manner of Death Z Natural Cause Accident ❑ Undetermined ❑Pending W C.) Homicide Suicide Circumstances Investigation CI Medical Certifier Name Title David DeCelle Coroner Address 40 McMaster Street, Ballston Spa,New York 12020 Death Certificate Filed Town Of Edinburg District Number Register Number City,Town or Village 4555 2 Burial Date Cemetery,Crematory or Facility Name ® 06/08/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town, New York Donation fl❑Removal Date Place Removed F and/or and/or Held N Hold Address 0 d Date Point of (A❑Transportation CI by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne, New York 12846 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped,If Other than Above a Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/08/2023 Registrar of Vital Statistics Denise Ferguson(Electronically Signed) (signature) District Number 4555 Place Town Of Edinburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition (p l 1173 Place of Disposition w '.L1L 4---..2 (address) W Cl) CC (section) (lot number) (grave number) 7 0 Name of Sexton or Person in Charge`, Pr miser r L.Z please printt Signature Title (r" i4117"/Z DOH-1555(07/18)p 1 of 2 26 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#