McCanney, Timothy J NEW YORK STATE DEPARTMENT OF HEALTH
Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Timothy J McCanney Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/05/2021 73 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
0 Manner of Death1=1Undetermined Pending
W Natural Cause Accident Homicide Suicide
Circumstances Investigation
W Medical Certifier Name Title
O Sean Bain MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
_ City,Town or Village Glens Falls 5601 273
❑Burial Date Cemetery,Crematory or Facility Name
07/06/2021 Pine View Crematory
ElEntombment Address
X❑Cremation Queensbury Town,New York
❑Donation
0 Removal Date Place Removed
and/or and/or Held
~
usHold Address
O
a Date Point of
(I) ❑Transportation
p by Common Shipment _
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 12803
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/06/2021 Registrar of Vital Statistics Wpbert Andrew Curtis(ECectronica1TySigned)
(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 permit on:
Z
Date of Disposition lit/71 Place of Disposition
(address)
W
CC CC (section) number) II (grave number)
G Name of Sexton or Person in Charge of P mises g (lot
t'« � �u�
Z (plea le print)
W Cro
Signature Title ' YI"'t
DOH-1555(07/18)p 1 of 2
r_
Public Health Law Sec. 4145(2b) 1> .4��16
Receipt
Human remains of delivered on , 20
1
1
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#