McGuire, Timothy Michael NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Timothy Michael McGuire Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/21/2021 59 Years War or Dates
F- Place of Death Hospital,Institution or
Z City,Town or Village Hudson Falls Village Street Address 55 William Street, Hudson Falls Village,New York 12839
p Manner of Death Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
U Circumstances Investigation
ILLII Medical Certifier Name Title
CI Christopher Mason DO
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Hudson Falls Village 5726 22
❑Burial Date Cemetery,Crematory or Facility Name
08/24/2021 Pine View Crematory
❑Entombment Address
0 Cremation Queensbury Town,New York
❑Donation
Date Place Removed
O ❑Removal
r and/or and/or Held
N Hold Address
0
0- Date Point of
U) ❑Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
❑Disinterment
❑Reinterment Date Cemetery Address
Permit 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
I— Remains are Shipped,If Other than Above
Address
CC
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/23/2021 Registrar of Vital Statistics Cynthia ABardin(ECectronica1TySigned)
(signature)
District Number 5726 Place Hudson Falls Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IF-
W M;Date of Disposition �j oj Place of Disposition �G y:t..., (de dt>'
g 6 (address)
W
CC (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises C,lyn-t./ ;r-c.s
Z (please print)
W Signature Title C.rP✓+^r1�Gl�
DOH-1555(07/18)p t of 2
ri
. 064
Public Health Law Sec. 4145(2b)
i' Receipt
' Human remains of %'; '';'` �'','f delivered on , 20
Pine View Cemetery Representing the funeral home named op,hur}alyermit
Official Funeral Directors Reg.or License# t r