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Monroe, Wilbur James Jr. /oZ5 - NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Wilbur James Monroe Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 12/19/2023 87 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Horicon Town Street Address 6764 State Route 8,Horicon Town,New York 12815 `LI p Manner of Death Natural Cause Accident Homicide Suicide Ej Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title CI Hilary Jones NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Horicon District Number Register Number City,Town or Village 5654 11 RBurial Date Cemetery,Crematory or Facility Name 12/20/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York IIIDonation ❑Removal Date Place Removed and/or and/or Held - Hold Address N 0 CL Date Point of V) Transportation by Common . Shipment Carrier Destination E Disinterment Date Cemetery Address n Reinterment Date Cemetery Address 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 Remains are Shipped,If Other than Above S Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/19/2023 Registrar of Vital Statistics KristaG Wood(ECectronica1Ty Signed) (.ignature) District Number 5654 Place Town Of Horicon I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH W Date of Disposition 12 To I 73 Place of Disposition 3rilrut4 At' 414Z030d1.. 2 (address) W (section) number) (grave number) 8 Name of Sexton or Person in Charge of Premises /rot P — ift (plea e print) Signature Title 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# �''