Lattimore, Jeffrey Thomas y if /133
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Jeffrey Thomas Lattimore Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/14/2020 58 Years War or Dates
H Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death g Natural Cause ❑Accident ❑Homicide Suicide ❑Undetermined Pending
W
V Circumstances Investigation
W Medical Certifier Name Title
CI Robert Reeves MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 471
❑Burial Date Cemetery,Crematory or Facility Name
10/17/2020 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury,New York
❑Donation
Z❑Removal Date Place Removed
and/or and/or Held
11-
Hold Address
0
EL Date Point of
(/) ❑Transportation Shipment
G by Common
Carrier Destination
❑Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
` Name of Funeral Home Regan&Denny Funeral Service 01444
Address
94 Saratoga Ave,S Glens Falls,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F- Remains are Shipped,If Other than Above
2 Address
fr
W
o, Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/16/2020 Registrar of Vital Statistics lepiert.,grufrew Curtis(ikectronicalFySrguei
(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 perm J on. 11''
Z Date of Disposition �11q 170 Place of Disposition / I w VI,- 4
W address)
2
W
NCC (section) I (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises P n44.441h
z
( ease pn
W Signature a Title � 1�W�
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 014123
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#