Timpson, Franklin NEW YORK STATE DEPARTMENT OF HEALTH f "1 it 8 09
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
il Franklin C Timpson Male
ri Date of Death Age If Veteran of U.S. Armed Forces,
10/06/2018 74 Years War or Dates
Place of Death Hospital, Institution or
n City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death 0 Natural Cause O Accident O Homicide O Suicide O Undetermined ri O Pending
PY
Circumstances Investigation
Medical Certifier Name Title
i David Koren MD
4
Address
i 211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 532
11 OBurial Date Cemetery or Crematory
10/09/2018 Pineview Crematory
❑Entombment Address
v-®Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
5 Date Point of
• O Transportation Shipment
by Common Destination
;atv Carrier
O Disinterment Date Cemetery Address
--_ Date Cemetery Address
O Reinterment
ti
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
i.-, Address
-i" 7 Sherman Ave,Corinth,New York 12822
fal Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
• Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/08/2018 Registrar of Vital Statistics John T Franck(E[ectronical y Signed)
re
(signature)
i District Number Place
4501 Saratoga Springs, New York
,41
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
,44
Date of Disposition N(to (tr Place of Disposition PI„: 4440~
.. (address)
.,3 (section) (lot nu ber) (grave number)
Pr
Name of Sexton or Person in Charge of Premises n� 0i4 S$„,,ifi
(Please Prilt
7• 4
Signature 4 Title liziftliff41—
(over)
DOH-1555 (02/2004)