Spring, Tucker Francis r
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Tucker Francis Spring 7Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/21/2020 28 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
WManner of Death FINatural Cause Accident Homicide Suicide Undetermined Pending
() Circumstances Investigation
LU Medical Certifier Name Title
Connie Goedert Coroner
Address
1400 St Route 9,Lake George Town,New York 12845
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 189
❑Burial Date Cemetery,Crematory or Facility Name
04/27/2020 Pine View Crematory
Entombment Address
X❑Cremation Queensbury,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
~N Hold Address
0
IL Date Point of
0 R Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
❑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
H Remains are Shipped,If Otherthan Above
Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/27/2020 Registrar of Vital Statistics !kp6ea,4hlrewCratzr(Ekrtroaicaf Syiie4
(signature)
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 permit on:
Date of Disposition 4 ho alp Place of DispositionIJL /�,�
, �/I ot'lu
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lu (address)
W
N (section) (tot number) (grave number)
O Name of Sexton or Person in Charge of Premises << it
Z p ase print)
W Signature Title r�
DO H-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0 13 6 31.
Receipt
Human remains of delivered on , 20—
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#