Linendoll, Thomas NEW YORK STATE DEPARTMENT OF HEALTH
it 7LS -
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Thomas James Linendoll Male
Date of Death Age If Veteran of U.S. Armed Forces,
December 9, 2014 61 War or Dates
r; Place of Death Hospital, Institution or
City, Town or Village Street Address Saratoga Hospital
Manner of Death El Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
4. Circumstances Investigation
Medical Certifier Name Title
Anthony lammuccillo,
Address
Saratoga Hospital Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Number
�._ City, Town or Village 5 -T")
❑Burial Date Cemetery or Crematory
December 11, 2014 Pine View Crematory
. ❑Entombment Address
_ ®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ and/Remoroval and/or Held
Hold
Address
Date Point of
a, ❑Transportation Shipment
by Common Destination
0 Carrier
❑ Disinterment Date Cemetery Address
ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01078
Address
136 Main Street, South Glens Falls NY 12803
.' Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is her by ranted to dispose of the human remains-edmbover ' 'cated.
Date Issued Registrar of Vital Statistics -- r,
1 (signature)
District Number LI SDI Place 3,r _,Pr 'yr`'wUIL5
; .y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 12/11/2014 Place of Disposition Quaker Road Queensbury,NY 12804
P` (address)
(section) (lot number) (grave number)
i
Name of Sexton or Person in Charge of Premises . nvtiff.-- Sale '
XL (please print)
Signature Title Cv+!' ,
(over)
DOH-1555 (02/2004)