Muzikar, Joseph NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joseph F Puzi] ar Pi
Date of Death I Age If Veteran of U.S. Armed Forces,
fl June 22 , 2006 77 War or Dates 1 `4-6_194c'
Place of Death mown of Moreau Hospital, Idetitution or 13 Grover Ave
111
2 City, Town or Village Street Address South Glens Falls , NY 1 2_C 0 3
1 Manner of Death 0 Natural Cause 0 Accident 0 Homicide 0 Suicide 0 Undetermined El Pending
;}US
Circumstances Investigation
W Medical Certifier Name Title
Q Gerard Abess I D
Address
3 Ironnate Center Glens Falls , , NY 6
Death Certificate Filed Town of f\Ioreeu District Number Register Number
City, Town or Village
['Burial Date Cemetery or Crematory
Entombment ,71hnA 2"i , 2006 Pine View Crenatorj�
Address
Cremation Quaker Rod , Queen:sburv, NY 126G4
Date Place Removed
Removal and/or Held
and/or Address
H Hold
IA
O Date Point of
CL Trans ortation
❑ p Shipment
in by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to il.7;. -Kjleer Funeral Home Registration Number
Name of Funeral Home,3G Pia n St . South Glens a11s , NY 12CO3 01141
Address
136 Pain St . Glens Falls c NY 22
South - _ -- , 1�.- 03
Name of Funeral Firm Making Disposition or to Whom
IFS- Remains are Shipped, If Other than Above
a Address
t
la
CI.
:: Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued a3- Loc Registrar of Vital Statistics / _f_A,,e_.t 9 .i �,
(signature)
District Number 4 Jr'O Place / -71 ( e<_ ,
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
ILI Date of Disposition fir,z L Place of Disposition /1; .;i. v , ' ,. , ,L _-1 L,,3,,P rf- -t
2 (address)
CO
r (section) (lot number) (grave number)
ci Name of Sexton or Person in Charge of Premises r 14-4` t; ("-rz ,,- t;
z (please print)
W Signature (_< %�.,ram. (,-= � - Title r �. �ai i v -`
(over)
DOH-1555 (02/2004)