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Kuebler, Timothy A
11 NEW YORKSTATE DEPARTMENT OF HE ALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Timothy A Kuebler Male Date of Death Age If Veteran of US.Armed Forces, 06/09/2023 59 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital WW Manner of Death Natural Cause Accident Homicide ESuicide Undetermined ❑Pending V Circumstances Investigation C Medical Certifier Name Title Kasandra Frasier PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 292 Burial Date Cemetery,Crematory or Facility Name 06/13/2023 Pineview Crematory Entombment Address ©Cremation Queensbury Town,New York nDonation clEI Removal Date Place Removed and/or and/or Held p to Hold Address 0 O. Date Point of N❑Transportation p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom 1-. Remains are Shipped,If Other than Above a Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/12/2023 Registrar of Vital Statistics Megan Nolin(Electronically Signed) (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: F- W Date of Disposition 41 l3 1 13 Place of Disposition 2 (address) W N Q (section) (lot number) (grave number) 8 Name of Sexton or Person in.Charge of P ' s A L �H Z A *, (lease print) Ui FLf/N1 Signature Title (iv/Iwo/ DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 r Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# r