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Tucker, Jeffrey Nathan iv 1.7E) -tt to Cc NEW YORK STATE DEPARTMENT OF HEALTH _ Burial�, _ Bureau of Vital Records Transit Permit Name First Middle Last Sex Jeffrey Nathan Tucker Male Date of Death Age If Veteran of U.S.Armed Forces, 08/10/2023 30 Years War or Dates l- Place of Death Hospital,Institution or Z City,Town or Village Hartford Town Street Address State 40 Route,Hartford Town, New York 12838 W Manner of Death Undetermined Pending W Natural Cause Accident Homicide Suicide g U Circumstances Investigation W Medical Certifier Name Title CI Wesley Perry Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed Town Of Hartford District Number Register Number City,Town or Village 5759 8 HBurial Date Cemetery,Crematory or Facility Name 08/15/2023 - Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 CI. Date Point of U)❑Transportation p by Common Shipment Carrier Destination El Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above i Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/15/2023 Registrar of Vital Statistics Denise(Petteys(ECectronicaCCy Signed) (signature) District Number 5759 Place Town Of Hartford I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IF- Z Date of Disposition $I n I Z3 Place of Disposition 'wv 4'44--, W 2 (address) W NCC (section) (lot number) • (grave number) O Name of Sexton or Person in Charge of Premises r ' Z (p ase print) W Signature Title lmi-a2 DOH-1555(07/18)p 1 of 2 q. 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 • cial Funeral Directors Reg.or License#