Grimaldi, Joseph Ntv YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joseph A Grimaldi Male
Date of Death 1 Age 1 If Veteran of U.S. Armed Forces,
September 18,2011 79 1 War or Dates Korean
Li_ Place of Death Hospital, Institution or
2 City, Town or Village Glens Falls Street Address Glens Falls Hospital
aManner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
VCircumstances Investigation
W Medical Certifier Name Title
G Sean Bain,MD
Address
100 Park Street,Glens Falls,NY
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 (C/
❑X Burial Date Cemetery or Crematory
September 22, 2011 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queesnbury, NY
Date Place Removed
O _LiRemovai and/or Held
and/or
I— Hold Address
En
a I Date Point of
N Transportation Shipment
G by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Regan& Denny Funeral Home Registratio0iber
Name of Funeral Home
O uaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
I—. Remains are Shipped, If Other than Above
2 Address
GC.
W
d Permission is hereby ranted to dispose of the human reains described abovecas indicate .
Date Issued i
n/1 Registrar of Vital Statistics
(signature)
District Number 46/ Place Glens Falls / / /,y /2 i
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Pine View Cemetery
W Date of Disposition 9/22/2 01 Place of Disposition
Z. (address)
CO Seneca 20D 1
rt (section) (lot number) (grave number)
QName of Sexton or Person i Charge of Premises Mi chael Genier
Wz (please print)
Signature ¢wA-u"- Title Superintendent
(over)
nnl-I_1 F. 'S rn9/9nnal