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Beckowitz, James Donald 44-610 i , . ‘ NEW YORK STATE DEPARTMENT OF HEALTH ,. Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James Donald Berkowitz Male Date of Death Age If Veteran of U.S.Armed Forces, 07/25/2023 72 Years War or Dates Place of Death Hospital,Institution or Z 1!J City,Town or Village Warrensburg Town Street Address 3899 Main Street,Warrensburg Town, New York 12885 0 Manner of Death El Natural Cause Accident E Homicide Suicide nUndetermined In Pending SiLI Circumstances Investigation C Medical Certifier Name Title John Stoutenburg MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Town Of Warrensburg District Number Register Number City,Town or Village 5660 10 Burial Date Cemetery,Crematory or Facility Name 07/27/2023 Pine View Crematory Entombment — Address ©Cremation Queensbury,New York Donation o Removal Date Place Removed and/or Held ; and/or Hold Address CO O. Date Point of (I) Transportation Shipment Q by Common Carrier Destination Date Cemetery Address Disinterment El 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 H Remains are Shipped,If Other than Above a Address IC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/27/2023 Registrar of Vital Statistics Tamely M Gloytl(Electronically Signed) (signature) District Number 5660 Place Town Of Warrensburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 7 Z1'ZDZ3 Place of Disposition P;a G il;e4.3 G r" �r"M r� W ir N (section) Imo,a Yrrv''� '(lot number� z (grave number) SName of Sexton or Person in Charge f Pre ices (please print) al Title or sti r DOH-1555(07/18)pi of 2 i * rm.. 1 1 '''.7''' . 0 :._ ,.:. Public Health Law Sec. 4145(2b) Receipt Human remains of --_t . delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#