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Lynch, James R • !T.?, NEW YORKSTATE D �" ' 1F \ it 6 • 1 EPARTMENTOFHEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex James R.Lynch Male Date of Death Age If Veteran of U.S.Armed Forces, 08/12/2023 68 Years War or Dates 1973-1977 ... Place of Death Hospital,Institution or W City,Town or Village Speculator Village Street Address 153 Elm Lake Road,Speculator Village, New York 12164 p Manner of Death El Natural Cause ❑Accident Homicide Suicide Undetermined Pending W V Circumstances Investigation Q Medical Certifier Name Title Timothy Smith Coroner Address PO Box 667,Lake Pleasant,New York 12108 Death Certificate Filed Village Of Speculator District Number Register Number City,Town or Village 2020 1 Burial Date Cemetery,Crematory or Facility Name ® 08/14/2023 Pine View Crematorium Entombment _ Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed p and/or and/or Held N Hold Address 0 O. Date Point of (I)❑Transportation 0 by Common Shipment Carrier Destination []Disinterment Date Cemetery Address Date Cemetery Address I I Reinterment Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/14/2023 Registrar of Vital Statistics Crysta(O'6rien(E(ectronicallySigned) (signature) District Number 2020 Place Village Of Speculator I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition Si IS I Z3 Place of Disposition ,.. 2 raddress) LU U) Q (section) (lot number) (grave number) SName of Sexton or Person in Charge of Premi es /Ar. ,t.__ Sts,4 n 'Z (please print/ i Signature Title 1'Qfrtnori/e DOH-1555(07/18)p 1 of 2 1 • t 1 11 7 1 )q 1 Public Health Law Sec. 4145(2b) Receipt Human remains of , I delivered on , 20 -- ia- Pine View Cemetery Representing the funeral home named Pi burial permit Official Funeral Directors Reg.or License# / `t