Northrup, Timothy 92
NEW YORK STATE DEPARTMENT OF HEALTH s , No
Vital Records Section , Burial - Transit Permit
Name First Timothy Middle Las�orthrup Sex Male
Date
0 f Death Age
59 If Veteran of U.S. Armed Forces,
yearsWar or Dates
}- Place of Death Hospital, Institution or
Ci , awn or ViIX GreenfieldLti Street Address 29 Daniels Road, Greenfield
Manner of Death Natural Cause ❑Accident ElHomicide ElSuicide 1-1❑Undetermined ri❑Pending
aCircumstances Investigation
ul Medical Certifier Name Title
O Edward M. Liebers M D
Addr4 care Lane, Suite 300, Saratoga Springs, N Y 1286
Death Certificate Filed District Number Register Number
CiMwn or Vil Greenfield 4557 12
Ni❑Burial Date Cemetery or Crematory
07/28/2014 Pine View Crematorium
❑Entombment Address
cremation Queensbury, New York
Date Place Removed
Z Removal and/or Held
2 and/or Address
I= Hold
t
0 Date Point of
ti El Transportation Shipment
Ls by Common Destination -
Carrier
Q Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc. 00364
Address
402 Maple Avenue, Saratoga Springs, N Y12866
Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
• Address
IX
to
Pi Permission is hereby granted to dispose of the human re - s desc, . -d above a indi ated.
Date Issued 07/28/2014 Registrar of Vital Statistics ' t �, - ' ? ;Nap/444
(signature) lV
District Number 4557 Place Greenfield
I certify that the remains of the decedent identified above were disposed of inaccorda e with this permit on:
tii• Date of Disposition o2 5V Place of Disposition R/v4 //c�1 l'Aey.
(address)
iLI
cn
(section) of number) (grave number)
CI Name of Sexton or e' • i► �ge of Premises �� Ko 14)'`J
�� /J (pleas print)
i Signature C` i c�L Title C�-EGi��'1 ✓� '��
(over)
DOH-1555 (02/2004)