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Winters, James Stanley
11-0 NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James Stanley Winters Male Date of Death Age If Veteran of U.S.Armed Forces, 08/24/2023 51 Years War or Dates F. Place of Death Hospital,Institution or WCity,Town or Village Northumberland Town Street Address 10 James Court, Northumberland Town, New York 12831 pManner of Death Natural Cause Accident Homicide Suicide Undetermined ❑Pending Circumstances Investigation IIIQ Medical Certifier Name Title John Pezzulo DO Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed Town Of Northumberland District Number Register Number City,Town or Village 4563 14 Burial Date Cemetery,Crematory or Facility Name 08/28/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation g❑Removal Date Place Removed and/or and/or Held - Hold Address 0 a. Date Point of (/) Transportation Ell Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 5 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/28/2023 Registrar of Vital Statistics Denise D Murphy(ECectronica((y Signed) (signature) District Number 4563 Place Town Of Northumberland I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 2 Date of Disposition 3`Z91p43 Place of Disposition f Aie t eJ 2 (address) W N CC (section) (/ (lot number)' (grave number) g Name of Sexton or Person in C7s /' Pre e 7 Nl 0 LU q�[�l Z (please print) W Signature �� Title b $4-41#r DOH-1555(07/18)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#