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Tucker, Allen Perry
-# 9O • NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of VitaL Records Name First Middle Last Sex Allen Perry Tucker Male Date of Death Age If Veteran of U.S.Armed Forces, 01/29/2022 68 Years War or Dates 1971-1975 Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death © ❑Su �Undetermined Pending U.) Natural Cause Accident Homicide Suicide V Circumstances Investigation W Medical Certifier Name Title Q Gamal Khalifa MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 67 ❑Burial Date Cemetery,Crematory or Facility Name 01/31/2022 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ▪Donation Removal Date Place Removed and/or and/or Held �- Hold Address 0 O. Date Point of N ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom 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 01/31/2022 Registrar of Vital Statistics Megan Nolin(E(ectronicalTy Signed) (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 j/30 ZZ Place of Disposition FF111 t� lift✓-- (address) W U) (section) (lot number) _ (grave number) gName of Sexton or Person in Charge of Premises r • �"-� �tf� Z (pl se print) W Signature (J` i Title lMAria, DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on < , 20 t a 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#