Pratt, Timothy NEW YORK STATE DEPARTMENT OF HEALTH
1.1
Vital Records Section Burial - Transit ermit
:, Name First Middle Last Sex
Timothy K. Pratt Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 28, 2011 I 66 1 War or Dates
Place of Death ' Hospital, Institution or
Z: City, Town or Village Glens Falls Street Address Glens Falls Hospital
aManner of Death I X]Natural Cause Accident n Homicide Suicide 'Undetermined Pending
-L Circumstances Investigation
Wo Medical Certifier Name Title
Gary Scidmore Coroner
:;:, Address
1340 State Rt 9 Lake George,NY
.: Death Certificate Filed District Number 0 i Register Nu er
City, Town or Village Glens Falls ��
❑Burial Date Cemetery or Crematory
March 4, 2011 Pine View Crematorium
❑Entombment Address
1 Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
ZZ I I Removal and/or Held
and/or Address
F' Hold
N
0 Date Point of
N Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
, ili Permit Issued to Registration Number
Name of Funeral Home Regan& Denny Funeral Home 01464
A Address -
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
:M' Remains are Shipped, If Other than Above
; Address
tt
JO
,. Permission is he eby granted to dispose of the human emains scribed.abovvee as i dic• ed.
Date Issued Registrar of Vital Statistics gte ail-L\_�"/ 2 _
(signature)
District Number j —j/ Place Glens Falls
I certify that the remains of the decedent identified above were dispose of in accordance with this permit on:
Z W Date of Disposition z-?-!I Place of Disposition 1 n.�J,tv Crf/01+00.0%.
W (address)
W
tY
(section) ( number) (grave number)
QName of Sexton or Person in Charge f Premises �in j��i' .rt4it--
`Z li gdITL„, (please print)
SignatureTitle C12ee,roOe.,
(over)
DOH-1555(02/2004)