Martino, Joseph NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last I Sex
Joseph Martino Male
Date of Death Age If Veteran of U.S. Armed Forces,
::.: December 11, 2013 94 War or Dates World War II
•.: Place of Death
1 Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death g Natural Cause Accident I I Homicide I Suicide I Undetermined I Pending
Circumstances 'Investigation_
Medical Certifier Name Title
g' N. Siodioni MD.
1 Address
::::`100 Park Street,Glens Falls,NY 12801
:: Death Certificate Filed District Number Register Num r
t1 City, Town or Village Glens Falls j 5601
� q l
Burial I Date Cemetery or Crematory
IcS�. ) - c3❑Entombment Address ��3
❑Cremation j
Date TPlacei Removed
Z x Removal _ and/or Held __ ____
O and/or , ,.caress _�
=' Hold
o to
L Date — Point of
a.
W Transportation Shipment
a by Common I Destination
Carrier
I I Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
::Name of Funeral Home Regan & Denim Funeral Home 01444
Address
94 Saratoga Avenue, South Glens Falls, NY 12803
•` Name of Funeral Firm Making Disposition or to Whom
i4: Remains are Shipped, If Other than Above _
Address
Permission is her y ranted to dispose of the human remains described above as indicated.
Date Issued ' 13I J Registrar of Vital Statistics 1\"-)J~J`{c.: (signs re)
District Number 5601 Place Glens Falls
t:.
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Zi—
iii Date of Disposition S/31 i y/ Place of Disposition LM et/re R ti Out,ers hJ.) Al f
(address)
u, 1YI
N
Qo (secf n) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises /9,,+ I r . '/6
Z (please print)
Signature Title M444r I _
J (over)
DOH-1555(02/2004)