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Tyminski, Nathan J IS)NEW YCJRKSTATE DEPARTMENT OF HEALTH 3 3-1Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Nathan J.Tyminski Mate Date of Death Age If Veteran of U.S.Armed Forces, 04/22/2022 32 Years War or Dates Place of Death Hospital,Institution or Z City,town or Village Hudson Falls Village Street Address 1 Spring Street,Hudson Fails Village,New York 12839 © Manner of Death El Natural Cause nAccident pi Homicide nSuicide I lUndeterrnined in 111 "Circumstances I !Investigation W Medical Certifier Name Title © Robert Lemieux Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed Village Of Hudson Falls District Number Register Number City,sown or Village 5726 23 Burial Date Cemetery,Crematory or Facility Name 04J26/2022 Pine View Crematorium nEntombnrent Address LICrernation Queensbury Town,New York nDonation Z❑Removal Dale Place Removed andr'or and/or Held N Hold Address 0 a. Date point of N In f ransportation Shipment © by Common Carrier Destination Dale Cemetery Address DDisintennent Date Cemetery Address keirderment Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67.Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,It Other than Above 2 Address IC to a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/26/2022 Registrar of Vital Statistics Cyn .aBunfur%E ann:i14,Sgmd (s ku,vlurc>" District Number 5726 Place Village Of Hudson Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition y In In Place of Disposition e47/cVN•• w (ad/1,e»l wl CC CC (Secili nj (lot number/ (;rvre number,/ g Name of Sexton or Person in Charge of Premises rh "r Am Ir (,olc se[lila! w /���"� ;ale f"r'/l�!'�QJ 4 Signature DOH-1555(07/18)p rot 2 C a s r: Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial/permit Official Funeral Directors Reg.or License#