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Strong, James Patrick tl iv03 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James Patrick Strong Male Date of Death Age If Veteran of U.S.Armed Forces, 07/21/2023 31 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 13 Pershing Road,Queensbury Town, New York 12804 (a Manner of Death 0 Natural Cause nAccident El Homicide ZSuicide riUndetermined []Pending W U Circumstances I /Investigation W Medical Certifier Name Title a Paul Bachman MD Address 3767 Main Street,Warrensburg Town,New York 12885 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 117 Burial Date Cemetery,Crematory or Facility Name 07/27/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York ▪Donation o❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 Date Point of (I)0Transportation Shipment Q by Common Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address Reinterment Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom F.- Remains are Shipped,If Other than Above ,_. Address CC W 0' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/26/2023 Registrar of Vital Statistics Caroline Hildegarde Barber(Electronically Signed) (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: f— W Date of Disposition Z j�-1oZj Place of Disposition L �+ �� �(ad )� W Cl) (section) (lot number (grave number) 0 Name of Sexton or Person in Char of Premi �A'rrn0^� Q (please print) Z rr W Signature Title or-f—ra,-+-c..- DOH-1555(o7/18)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#