Blood, Terrance John (( � loo
T)
NEW YORK STATE DEPARTMENT OF HEALTH _ it
E Burial Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Terrance John Blood Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/16/2022 80 Years War or Dates 1962-1965
H Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital
p Manner of Death El Natural Cause Accident 0 Homicide Duicide EIUndetermined F.—rending
W
U I—ICircumstances Investigation
W Medical Certifier Name Title
C3 Mark Weidner MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 744
Burial Date Cemetery,Crematory or Facility Name
12/20/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
n. Date Point of
t/) Transportation Shipment
p by Common
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
1-- Remains are Shipped,If Other than Above
5 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/19/2022 Registrar of Vital Statistics Dillon Moran(ECectronicaCCySigned)
(signature)
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—Z Date of Disposition 12170 1 Z2 Place of Disposition s k_ 46---
W (address)
W
NCC (section) A (lot number) (grave number)
0 ` � h
Name of Sexton or Person in Charge of Premises „ �— "��
0 / (pile e print)
w ra m�rvie
Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) '' )1,
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#