Timms, Gary , ,1, 353
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Gary Dwight Timms Male
Date of Death Age If Veteran of U.S. Armed Forces,
May 13, 2015 66 War or Dates n/a
Place of Death Hospital, Institution or
City, Town or Village Glens Falls, NY Street Address Glens Falls Hospital
Manner of Death (XI Natural Cause Accident I I Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
gi Aqeel Gillani,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls, NY 5601 c 9.9'
❑Burial Date Cemetery or Crematory
May 14, 2015 Pine View Crematorium
❑Entombment Address
❑x Cremation 21 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
Hold
U)
O Date Point of
O.
Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
;. Permit Issued to Registration Number
':; Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12804
°;: Name of Funeral Firm Making Disposition or to Whom
}*+ Remains are Shipped, If Other than Above
S Address
r
Permission is hereb granted to dispose of the human r mains des ribed abo as indica -d.
Date Issued 13 I Registrar of Vital Stati ics /_E—i- L g2/`--(
(signature)
District Number .66 i Place
0/2
I— I certify that the remains of the decedent identified above were disposed of in accordance with is permit on:
WDate of Disposition Place of Disposition
2 (address)
W
U)
Ce (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises
Z (please print)
W
Signature Title
(over)
DOH-1555(02/2004)