Timms, Sidney Paul -IN9
NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Sidney Paul Timms I Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/05/2020 78 Years War or Dates Navy
Place of Death Hospital,Institution or
City,Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death 91 Natural Cause Accident Homicide Suicide Undetermined Pending
VCircumstances Investigation
{N Medical Certifier Name Title
O Stephen Perazzelli MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 12
ElBurial Date Cemetery,Crematory or Facility Name
01/07/2020 Pine View Cemetery
Entombment Address
X❑Cremation Queensbury,New York
❑Donation
0z Removal Date Place Removed
and/or and/or Held
QN
Hold Address
a Date Point of
N ❑Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
i
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom j
} Remains are Shipped,If Other than Above
Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/07/2020 Registrar of Vital Statistics �R.o6errgndrewCrirtzr(ElectronicaTSigned
(signature)
District Number 5601 Place Glens Falls, New York
t I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
G Date of Disposition 11 7o Place of Disposition art 'j rt'--�
W (address)
W
(section) (tot nu r/ (grave number)
A.
8 Name of Sexton or Person in Cha e of Premise `
om
(please print)
W Title M
Signature
DOH-1555(o7/t8)p t of 2
Public Health Law Sec. 4145(2b) 013212
Receipt
Human remains of �, �, = delivered on , 20
j
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
Town of Queensbury
Certification of Cremation
(DW Pine View Cemetery and Crematory
This certifies that the remains of: Sidney Timms
were cremated on January 7 20 20 at the Pine View
(Month) (Day)
Crematorium, Queensbury, New York, and these are the cremated remains of said body.
Date of Death January 5 2019 Age 78
(Month) (Day)
Funeral Home Singleton Sullivan Potter Registered No. 18
(Authorized Signature)
TIMMS
NAME Sidney P. Timms Age: 78
Lot Owner:
Sidney P. & Elaine Timms
Lot# 33 G Grave# 1
Case:
URN
Died: Interred:
1 /5/2020 1 /9/2020
Funeral Home:
Singleton Sullivan Potter
Cemetery:
Pine View Cemetery