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Gurney, James Edward U . . NEW YORK STATE DEPARTMENT OF HEALTH Burial- Transit Permit Bureau of Vital Records Name First Middle Last Sex James Edward Gurney Male Date of Death Age if Veteran of U.S.Armed Forces, 10/29/2023 27 Years War or Dates i,,. Place of Death Hospital,Institution or Z City,Town or Village Plattsburgh Street Address 25 Durand Street Apt.A,Plattsburgh,New York 12901 IJJ p• Manner of Death Natural Cause Accident 0 Homicide Suicide Undetermined Pending C) L—ICircumstances Investigation aLU Medical Certifier Name Title Chad Deans Coroner Address 137 Margaret Street Ste 208,Plattsburgh,New York 12901 Death Certificate Filed City Of Plattsburgh District Number Register Number City,Town or Village 0901 484 Burial Date Cemetery,Crematory or Facility Name 10/31/2023 Pineview Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation ❑Removal Date Place Removed and/or and/or Held ~ asHold Address 0 LI. Date Point of V)❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom 1.. Remains are Shipped,If Other than Above a Address OC W CI. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/30/2023 Registrar of Vital Statistics Sylvia Gail Parrotte(Electronically Signed) (signature) District Number 0901 Place City Of Plattsburgh I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition to I 31 t13 Place of Disposition 4 U-i-r=,,.,t C 4TO12rfr•.... 2 (address) W VI (section) (lot number) (grave number) O Name of Sexton or Person in Cha f Premises �'71, -f�1 Z (p a print) IW Signature Title tirYi DOH-1555(o7/18)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#