Timms, Marjorie NEW YORK STATE DEPARTMENT OF HEALTH ' t Vital Records Section Burial - Transit Permit
Name First !l Middle Last Sex
Marjorie Timms Female
Date of Death Age If Veteran of U.S. Armed Forces,
February 8, 2012 �'� War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
ILI
• Manner of Death X Natural Cause I I Accident I I Homicide Suicide Undetermined Pending
tit, Circumstances Investigation
j Medical Certifier Name Title
Dr Derek Smith,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls,NY 5601 .5-7
❑Burial Date 1 Cemetery or Crematory
February 10, 2012 ': Pine View Cremation
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date j Place Removed
Z Removal 1 and/or Held
and/or Address
H Hold
O Date 1 Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
.; Permit Issued to Registration Number
Name of Funeral Home Regan & Denny 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
g, Address
CZ
US,
k Permission is hereby granted to dispose of the human remains describe above a ' dic e .
Date Issued Oo 010i10/2—Registrar of Vital Statistics � �i2
(signature)
, District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z v C.iti1,c
� Date of Disposition �� It), Z.U►1 Place of Disposition �..+ u.J fUf•�w�
(address)
W
CO
0: (section) 4 , (lotjwmber) (grave number)
Q Name of Sexton or Per on in Charge of Premises `%c,si e t vir4tr
Z (please print)
W Signature 4p-L_ --4
Title C CAI ii-1
(over)
DOH-1555(02/2004)