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Hanna,Timothy William a 4 s-ic NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Timothy William Hanna Male Date of Death Age If Veteran of U.S.Armed Forces, 07/11/2021 68 Years War or Dates 1972-1978 H Place of Death Hospital,Institution or W City,Town or Village Albany Street Address Albany Medical Center Hospital O Manner of Death © Natural Cause ❑Accident ❑Homicide Suicide Undetermined ❑Pending W U Circumstances Investigation W Medical Certifier Name Title a Jacqueline Sayres PA Address -43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed,.., District Number Register Number City,Town or Village "* Albany 0101 1761 ❑Burial Date Cemetery,Crematory or Facility Name 07/13/2021 Pine View Crematory ❑Entombment Address lCremation Queensbury Town,New York Donation Z ❑Removal Date Place Removed and/or and/or Held ~ o Hld Address d Date Point of CO LI Transportation Shipment Q by Common Carrier Destination ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address Pefmit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/13/2021 Registrar of Vital Statistics Danielle S Gillespie(Electronically Signed) (signature) District Number 0101 Place Albany, 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 '11 t 114 Place of Disposition f .1tL 2 (address) W N (section) (lot number) (grave number) 0 .S a Name of Sexton or Person in Charge of Premi s '�' l lease print) 1 �y� W Signature Title C1 4 t - DOH-1555(07/18)p 1 of 2 .. i Public Health Law Sec. 4145(2b) ® •` Receipt Human remains of delivered on , 20 `{ 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#