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Hill, Timothy S
11. , tt, s_0 e2 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Timothy S.Hill Male Date of Death Age If Veteran of U.S.Armed Forces, 06/20/2023 58 Years War or Dates l— Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ❑^ Natural Cause Accident ❑Homicide 0Suicide FlUndetermined Pending W U Circumstances Investigation W Medical Certifier Name Title CI Asim Chaudry MD 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 306 ElBurial Date Cemetery,Crematory or Facility Name 06/22/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York ▪Donation ZO❑Removal Date Place Removed and/or and/or Held F- Hold Address N 0 d Date Point of U) Transportation • Shipment p by Common Carrier Destination Disinterment Date Cemetery Address EIReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above . Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/22/2023 Registrar of Vital Statistics Megan.Narn(Electronicadj Signe19 (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— Z Date of Disposition 4 I 2j/l j Place of Disposition 4L W (address) W N CC (section) (lot number) (grave number) CName of Sexton or Person in Charge of Premises r �' AZ (p�ase print) W Signature /- Title ( y lvi DOH-1555(07/18)p 1 of 2 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# JS) Town of Queensbury Certification of Cremation NO> Pine View Cemetery and Crematory This certifies that the remains of: Timothy S Hill were cremated on June , 23 20 23 at the Pine View (Month) (Day) Crematorium, Queensbury,New York, and these are the cremated remains of said body. Date of Death June 20 20 23 Age 58 (Month) (Day) Funeral Home Singleton Sullivan Potter Registered No. 508 (Authorized Signature) WELCH Lot No. 1081 \ddress VanDusen Rd. , West Glens Falla, N.Y. Section No. 22 )wner Walter Welch Plot Uncas )ate December 31, L968 100 Superficial ft. @$1.50 per sq. ft. vocation Bounded on North by Path, East by Path pnd let of Dotson, West by Vacant, South by Path. corner Posts remarks )eed No. (and changes) 1081 'ayment Record Paid in full December 31, 19618 'Form No. 01 Record of Interments N,b . Co-01-1. 3 _1 LL Edward J. Hill Sr.- (6/23/78) r1_f CiO -7G l u t i. 'a-a �r - tc `t- a: pc� Walter E. Welch (7/23/73) tad 31 i�8 / Florence Welch 1'D •28 7 �S aw CYI,c.kckt-[ 14; 1( 3 - aa gg i 8 3•a4-8(o nl ft - / \ X I y 7-51 '/) T/i HILL NAME Timothy S. Hill Age: 58 Lot Owner: Walter Welch Lot# Uncas Sec 22 Lot 1 081 Grave# 2A Case: Urn Died: 6.2 0.2 3 Interred: 6.3 0.2 3 Funeral Home: Singleton Sullivan Potter Cemetery: Pine View