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Barrett, James William F ilt NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James William Barrett Male Date of Death Age If Veteran of U.S.Armed Forces, 01/08/2024 82 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death El Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title CI Aaron Heckler PA 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 17 Burial Date Cemetery,Crematory or Facility Name 01/12/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Eland/or Removal Date Place Removed and/or Held H Hold Address 0 _ C- Date Point of (I)❑Transportation p by Common Shipment Carrier Destination oDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway, Fort Edward, New York 12828 Name of Funeral Firm Making Disposition or to Whom F. Remains are Shipped,If Other than Above a Address fE W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/09/2024 Registrar of Vital Statistics MeganWol'n(E(ectronica((ySigned) (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: H �/ Date of Disposition //3--z,z y Place of Disposition ;r.1 Q Ur'e ) etCyYJ, ,-it,{-- 2 (address) WCC /f U) / (section) (lot number) (grave number) gName of Sexton or Person in Charge of Pre ses 1? AYii7o tihoA Z ii (please print) W Signature Title n�e' ,G b!— DOH-1555(07/18)p 1 of 2 in Public Health Law Sec. 4145(2b) Receipt Human remains of t ' delivered on , 20/.' Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# i f