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Ray, James Claude If-ik, 4 NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James Claude Ray Male Date of Death Age If Veteran of U.S.Armed Forces, 01/02/2024 88 Years War or Dates F— Place of Death Hospital,Institution or WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital p Manner of Death 0 Natural Cause Accident 0 Homicide 0Suicide nUndetermined El Pending W V L I1Circumstances II 'Investigation W Medical Certifier Name Title G Jason Bernad MD Address • 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed City Of Saratoga Springs District Number Register Number City,Town or Village 4501 3 Burial Date Cemetery,Crematory or Facility Name 01/04/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0 Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 Date Point of U)❑Transportation Shipment p by Common Carrier Destination Date Cemetery Address Disinterment 0 Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom F.. Remains are Shipped,If Other than Above `„t• Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/03/2024 Registrar of Vital Statistics Dillon Moran(Electronically Signed) (signature) District Number 4501 Place City Of Saratoga Springs I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— WDate of Disposition II SIN Place of Disposition �'t Viit J PONVIF tit).— 2 (address) W 11 N (section) /hhv iL` If l(!ot plumber/ 't (grave number) 1/g Name of Sexton or Person in Charge p remises kz / (p ase print) LU 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#