O'Tier Jr., John NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
.0 John Joseph O'Tier, Jr. male
Date of Death 02/10/2018 Age 71 If Veteran of U.S. Armed Forces,
War or Dates Navy
Place of Death Hospital, Institution or
City, Town or Village South Glens Falls Street Address 17 Marine Drive
Manner of Death I X�Natural Cause 1 Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
William Tedesco, MD
'. Address
..� 3 Irongate Center, Glens Fall.3, 7'7
er� Death Certificate Filed District Lumber Regis Number
:, City, Town or Village Moreau 45
❑Burial Date Cemetery or Crematory
❑Entombment 02/14/2018 Piny View Crematory
Address
®Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
and/or Address
1, Hold
U)
0 Date Point of
a.
u) Transportation Shipment
a by Common Destination
Carrier
n Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
n'°r Permit Issued to
;.;�, Registration Number
r: Name of Funeral Home Regan and Denny Funeral Home 01444
0 Address
94 Saratoga Ave South Glens Falls, NY
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 re described bo as indicated.
a.;.: Date Issued /1//--//c)0/ C� Registrar of Vital Statistics (; 4 / CA
i: (sign�tfire)
District Numbert4no I(IS 4, quelaLtf, Aul. og)?
Place 3S 1 a
g......
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition -nib_.f 8 Place of Disposition p;i1t, V:kW C.,ivr+e kry
W (address)
CO
QM (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises �ja'4•v1e,)r St,v,rstS
Z (please print)
W
Signature Title C,,rt,rna-tor
(over)
DOH-1555(02/2004)