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James, Kellie Rae • 9 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit ,...... i 1(17,F) Bureau of Vital Records Name First Middle Last Sex Kellie Rae James Female Date of Death Age If Veteran of U.S.Armed Forces, 09/20/2023 55 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital ILI p Manner of Death n Natural Cause Accident ❑Homicide nSuicide nUndetermined ❑Pending IliI 'Circumstances Investigation U W Medical Certifier Name Title CI Scott Biasetti MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 440 nBurial Date Cemetery,Crematory or Facility Name 09/25/2023 Pine View Cemetery nEntombment Address Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 a. Date Point of t/)nTransportation p by Common Shipment Carrier Destination FiDisinterment Date Cemetery Address nReinterment 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 H Remains are Shipped,If Other than Above a Address tr UJ! O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/22/2023 Registrar of Vital Statistics Megan NoIin((Electronically Signed) (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z �/ W Date of Disposition q. 'a S p��j Place of Disposition 1 �lil�� 2 (u PJ t U� a�� 2 (address) W t-A.aS—©i-14G a t!) (section) � /lo�ber/ (grave number) 0▪ Name of Sexton or Person in Charge of Premises C (please print) W Signature 41M4Loer: Title - U+c�,`'tAl—�� �1� DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 012996 Receipt Human remains of delivered on , 20 / A 4.x•-.1 i,1.4 ,.--- 7 - View Cemetery e LRepresenting the funeral home named on burial permit cial Funeral Directors Reg.or License# JAMES Lot No. 2 4-G [dress r I ; n,, ► a n= e n s b u r y , N Y 12.8 n 1 Section No. � wner Steven & Plot Huron ite 2/12/01 Approx . 33 Superficial ft. fa cation Bounded on North by Road , South by Blackman , East by Blackman , West by Vacant . rner Posts marks .ed No. (and changes) 3078 _ yment Record Paid in Full 2/12/01 ($3 5 0 . 0 0) cord of Interments Trae Lindan James 2/ 12/01 144-A V& 1 �e � rn�s as � t�„b 9 ace a3 V 4 /4 X <C A 11, N 5 g 14,C-KM� m No. 01 James NAME Kellie Rae James Age: 55 Lot Owner: Steven & Kellie James Lot# Huron 24 G Grave# 1 Case: Concrete Died: 9.2 0.2 3 Interred:9.2 5.2 3 Funeral Home: Carleton FH Cemetery: Pine View