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Karge, James Randolph © 1;1- 21 CI NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex James Randolph Karge Male Date of Death Age If Veteran of U.S.Armed Forces, 03/19/2024 75 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 141 Feeder Dam Road, Moreau Town, New York 12803 p Manner of Death Ili Natural Cause Accident E Homicide OSuicide Undetermined ❑Pending LIJ 0Circumstances Investigation LU Medical Certifier Name Title 0 John Quaresima MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 18 BurialH Date Cemetery,Crematory or Facility Name 03/21/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held ~ Hold Address U) 0 O. Date Point of U)[]Transportation El Common Shipment Carrier Destination ODisinterment Date Cemetery Address Date Cemetery Address C Reinterment 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 1- Remains are Shipped,If Other than Above N Address C W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/21/2024 Registrar of Vital Statistics Brenda Hutter(Electronically Signed) (signature) District Number 4562 Place Town Of Moreau I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition 3I2/1711 Place of Disposition f' vct_J `P1-;i 1 W 2 (address) la U)CC (section) (lot number/ (grave number) 0 Name of Sexton or Person in Charge of Pre i ens "� C w'(It Z (pease print) W Signature ` Title li'1f2 DOH-1555(o7/i8)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#