Hunt, James Michael trvl
NEW YORK STATE DEPARTMENT OF HEALTH -
Bureau of Vital Records BurialTransit Permit
Name First Middle Last Sex
James Michael Hunt Male
Date of Death Age If Veteran of US.Armed Forces,
01/09/2024 71 Years War or Dates 1972-1973
i_ Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
p• Manner of Death IZI Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
CI Courtney Diamond NP
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
,Town or Village Cie 5601 21
Burial Date Cemetery,Crematory or Facility Name
01/10/2024 Pine View Crematory
Entombment Address
®Cremation Queensbury Town,New York
Donation
ZZ Removal Date Place Removed
and/or and/or Held
~ Hold Address
CO
0
0. Date Point of
(I)❑Transportation Shipment
p by Common
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
a Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/10/2024 Registrar of Vital Statistics Megan Holm(Efcctronically 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
IU Date of Disposition i I(21 29 Place of Disposition �r.ki0=11-61..) CI�*01,40 OrL„....,
2 (address)
W
torc (section) 'lot nuber) (Fare number)
g Name of Sexton or Person in Charge of Premises "r
if
Z (plV.—
print)
W fArfillet
Signature CV 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#