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Naylor, James Edward N -it-cc yc-- r - NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James Edward Naylor Male Date of Death Age If Veteran of U.S.Armed Forces, 01/06/2024 74 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death IZI Natural Cause Accident 0 Homicide OSuicide nUndetermined ❑Pending W Circumstances Investigation U Title W Medical Certifier Name CI Marcille Labban MD 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 16 Burial Date Cemetery,Crematory or Facility Name 01/11/2024 Pine View Crematory Entombment — Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 a. Date Point of U) Transportation Shipment p by Common Carrier Destination D Disinterment 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 IF— Remains are Shipped,If Other than Above 5. Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/09/2024 Registrar of Vital Statistics Megan NoCin(ECectronicaCCy 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: I~ WDate of Disposition ( (l2 tzc Place of Disposition fl'I'l O (Pi6Pt► VI1eli 2 (address) W CC CC (section) /(�it number) (grave number) 0 `//i,Name of Sexton or Person in Charge of Premis e'} H z (please pntl l` W Signature Title F 14 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#