Hill, Timothy Joseph ` \
1F
NEW YORK STATE DEPARTMENT OF HEALTH ' i � t
Burial - Transit Perm
Bureau of Vital Records
Name First Middle Last Sex
Timothy Joseph Hill Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/15/2022 71 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
p Manner of Death E Natural Cause ❑Accident Homicide ❑Suicide ❑Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 Courtney Diamond NP
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed city of Glens Fails District Number Register Number
C ,Town or Village 5601 471
Burial Date Cemetery,Crematory or Facility Name
09/16/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Removal Date Place Removed
and/or and/or Held
NHold Address
0
%I:Transportation Date Point of
a by Common Shipment
Carrier Destination
Date Cemetery Address
❑Disinterment
Date Cemetery Address
ElReinterment
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped,If Other than Above
5 Address
CC
EL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/16/2022 Registrar of Vital Statistics Megan.Wlrolrn(Eketrnnrcally.SYgned)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I— f� 1,
Z Date of Disposition 61 I►It I 71 Place of Disposition . ti.l.
2 (address)
W
Ncc (section) (lot number) (grave number)
4
8 Name of Sexton or Person in Charge mises ^" 1-
please print
W Title (VI�)�►t�i2
Signature
DOH 1555(o7/18)p 1 of 2
i
P
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# t"