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Connor, James Irving
72 10 { • { .ram i NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James Irving Connor Male Date of Death Age If Veteran of U.S.Armed Forces, 09/02/2023 77 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Hudson Falls Village Street Address 1 St Pauls Drive 6g, Hudson Falls Village,New York 12839 p Manner of Death ❑^ Natural Cause AccidentHomicide Suicide Undetermined El Pending C.) Circumstances Investigation W Medical Certifier Name Title CI Nicholas Montello NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Village Of Hudson Falls District Number Register Number City,Town or Village 5726 28 Burial Date Cemetery,Crematory or Facility Name 09/11/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York DDonation 0 Removal Date Place Removed and/or and/or Held Hold Address 0 O. Date Point of Cl)oTransportation Shipment p by Common Carrier Destination o 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 3 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/08/2023 Registrar of Vital Statistics Cynthia Bar�Cin(ECectronicaCCysigned) (signature) District Number 5726 Place Village Of Hudson Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition 1—//`2123 Place of Disposition ) e tJi Gfwi-w 2 (addres3) W N (section) (lot number) (grave number) O Name of Sexton or Perso Charge of Premises "/ ' (9 G'Y'' (please print) W Signature Title C��h t G �vr� � e DOH-1555(o7/18)pi o 2 PF .', .. ♦ Y � � of r" fi Public Health Law Sec. 4145(2b) 1 Receipt Human remains of -delivered on , 20 Pibe View Cefnetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#