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Pridell, Timothy David NEW YORKSTATE DEPARTMENT OF HEALTH Burial -Transit Permit Bureau of Vital Records Name First Middle Last Sex Timothy David Pridell I Male Date of Death Age If Veteran of U.S.Armed Forces, 04/1=020 55 Years War or Dates ZPlace of Death Hospital,Institution or City,Town or Village Glens Falls Street Address Glens Falls Hospital Mannerof Death Q Natural Cause Accident Homicide [:]Suicide Undetermined Pending U Circumstances Investigation WW Medical Certifier Name Title Scott Biasetti MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 183 Burial Date Cemetery,Crematory or Facility Name ❑Entombment 04/21/2020 Pineview,Crematory Address ©Cremation Queensbury,New York ❑Donation �Removal Date Place Removed 0 and/or and/or Held M Hold Address 0 WTransportation Date Point of p by Common —7Shipment Carrier Destination Disinterment Date Cemetery Address Reimerment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Iseneker Funeral Home Inc --700833 Address 5702 Waters Rd,Lowville,New York 13367 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/21/2020 Registrar of Vital Statistics `RQ&rt4�zdffWartzigkctrronua(fy.SYwd) (stgnaturel District Number 5601 Place Glens Falls. New York I certify that the remains of the decedent identified above were disposed of in accordance with this permiton: 2 W Date of Disposition 21- Place of Disposition jytp cQ r (address W (seethm) (tot number) (grave number) Name of Sexton or Per :inA arge of Premises Z (plea a print) Signature Title C 001-1-1555(07/18) of 2 Public Health Law Sec. 4145(2b) 013 5 9 7 Receipt Human remains of delivered on , 20 r Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License s'