Loading...
Mulcahy, Timothy NEW YORK STATE DEPARTMENT OF HEALTH Jt 3 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Timothy Joseph Mulcahy Male Date of Death Age If Veteran of U.S. Armed Forces, June 11, 2013 71 War or Dates Place of Death Hospital, Institution or in City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Deathly-1X Natural Cause ❑ Accident ❑ Homicide ❑ Suicide in Undetermined IT l l Pending L} Circumstances Investigation W Medical Certifier Name Title Marvin Davidowitz, M.D Address 100 Park Street Glens Falls, NY 12801 Death Certificate Filed District Number Register N4imbss City, Town or Village ,s-6 .5 ❑Burial Date Cemetery or Crematory June 17, 2013 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held o and/or Address E'' Hold (7' Date Point of , I I Transportation Shipment (i) by Common Destination 8 Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Reinterment Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom I—, Remains are Shipped, If Other than Above 2 Address W' a. Permission is hereby ranted to dispose of the human remains e cr ed ov ' dicated. Date Issued 20/3 Registrar of Vital Statistics , ,c/ (signature) District Number u40/ Place 6774 , ,;:/' 4),y • I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition /� W p bl(g�i� Place of Disposition ��� (rMc(n«.-- 2; (address) W CO W (section) 1 (lot number) (grave number) pName of Sexton or Per on in Charg of Premises A. Sprat- Z (pl se print) 41 Signature Title aletil49g- (over) DOH-1555 (02/2004)