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Little, Timothy RX Date/Time 07/02/2018 13:42 15185844843 P.001 4 ' 1 Ju1.02 .2018 03:12 PM COMPASSIONATE FUNERAL CAR 15185844843 PAGE. 1/ 1 NEW YORK STATE DEPARTMENT OF HEALTH ' Vital Records Section Burial - Transit Permit •` Name First Middle Last Sex 1 Timothy Michael Little Male ry Date of Death Age. .• If Veteran of U.S.•Armed Forces, . . 08/28/2018 65 Years: War or Dates , ,` Place of Death Hospital, Institution or . 2 City, Town or Village Saratoga Springs Street Address•Saratoga Hospital Manner of Death©.Natural Cause []Accident [�Homicide Suicide Undetermined Pending r, Name Circumstances Investigation �+ Medical Certifier Title , Rodney Ying MD . lf', Address . Lt. 211 Church St,Saratoga Springs,New York 12868 I , 'Death Certificate Filed " District Number Register Number • i; City, Town or Village Saratoga Springs • 4501. I ' 370 • I°Burial Date Cemetery or Crematory . 'q 07/02/2018 Pine View Crematory °Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ' .`'❑Removal and/or Held and/or Address r, Hold ..,� Date Point of r °Transportation Shipment by Common Destination '' Carrier El Disinterment Date Cemetery Address ' � Date Cemetery Address `;'.0 Reinterment I Permit Issued to Registration Number Name of Funeral Home Compassionate Funeral Care Inc 00364 ,; Address 402 Maple Ave,Saratoga Springs,New York 12886 Name of Funeral Firm Making Disposition or to Whom 'i:'i Remains are Shipped, If Other than Above Address o, rib l°x. Permission Is hereby granted to dispose of the human remains described above as Indicated. "'cA Date Issued 07/02/2018 Registrar of Vital Statistics join(r cranckgfectronicagy Signal M.' (signature) C; District Number 4501 Place Saratoga Springs, New York 1 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Id Date of Disposition 1/'a Id Place of Disposition (address) lit r;' (section) tr number) (grave number) Name of Sexton or Person in Charge of Premi es ,ia••"19 y /J� (plea print) w Signature �✓' Title atrEAWL. (over) DOH-1555(02/2004) • NEW YORK STATE DEPARTMENT OF NEALT Vital Records Section Burial - Transit Permit Name First Last I Sex NEW YORK STATE DEPARTMENT OF HEALT Vital Records Section Burial - Transit Permit uare or ueatn Age f U.S. Armed Forces, 8/16/2018 95 ates 1943-1945 Place of Death dal, Institution or Z City, Town or Village Moreau Street Address Home Of The Good Shepherd pManner of Death (X i Natural Cause [ Accident [Homicide n Suicide n Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title CI David Cunninham,MD Address 3 Irongate Center,Glens Falls,NY 12801 Death Certificate Filed District Number 1 Register Number City, Town or Village Town of Moreau,NY V 6(o X 4// ❑Burial Date Cemetery or Crematory August 17, 2018 Pine View Crematorium Ei Entombment Address ®Cremation 51 Quaker Road,Queensbury,NY 12804 Date Place Removed Z n Removal _ and/or Held 0 and/or Address F Hold N 0 Date Point of N1 Transportation I Shipment p by Common Destination Carrier Date ' Cemetery Address n Disinterment r--Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Road,Queensbury,NY 12804 Name of Funeral Firm Making Disposition or to Whom h- Remains are Shipped, If Other than Above 2 Address rL o. Permission is hereby granted to dispose of the human remains described above,� as indicated. Date Issued 8i1 ?// 8 Registrar of Vital Statistics 4. e (signature) District Number Cic(. vZ Place /06_)11 d r /X6 r ea i-- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 6 Z Date of Disposition .--..?,-I-t, Place of Disposition Pips,lttdito C,fe,r„c or i 2 (address) W Cn Ct (section) (lot number) (grave number) pName of Sexton or Person in Charge of Premises Qe-kIvICiy S DA,r aS Z (please print) IliiSignatur Title G fe,�+ a r e /1i /' r_� "�� (over) DOH-1555(02/2004)