Tucker, Ronald Albert Sr. ID . 4 7g-D.
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
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, Name First Middle Last Sex
Ronald Albert Tucker Sr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/28/2022 62 Years War or Dates
k Place of Death Hospital,Institution or
City,Town or Village Lake Luzerne Town Street Address 551 Lake Avenue,Lake Luzerne Town, New York 12846
`Q� Manner of Death El Natural Cause rnAccident ❑Homicide n
Suicide Undetermined Pending
'Circumstances Investigation
Medical Certifier Name Title
0 Paul Bachman MD
Address
9 Carey Rd,Queensbury Town,New York 12804
Death Certificate Filed Town Of Lake Luzerne District Number Register Number
City,Town or Village 5656 7
Burial Date Cemetery,Crematory or Facility Name
03/31/2022 Pine View Crematory
,. Entombment Address
EICremation Queensbury Town,New York
Donation
0Z❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
CI
IL Date Point of
(/) Transportation Shipment
C) by Common --
Carrier Destination
oDisinterment Date Cemetery Address
n 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
Remains are Shipped,If Other than Above
2 Address
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y11,
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/31/2022 Registrar of Vital Statistics Cynthia Sherwood-(ECectronicallySigned)
(signature)
District Number 5656 Place Town Of Lake Luzerne
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition /1 31 lit, Place of Disposition ?hr(L— ZilD ----
/,ddress)
W
a (section) Ai i(l`ot number) (grave number)
0 Name of Sexton or Person in Charg o Premises ``1 "'� �N mar
Z (please printT
Ill 1 W
Signature Title
DOH-1555(07/18)p 1 of 2
',4 1
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#