Loading...
Letizia, Michael • r '- NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name FirsMichael Middle A. LL ttizia Sex Male Da1660106 Age85 years If Veteran of U.S. Arm d Forces War or Dates Air Force 1951-1952 Place of Death Hospital, Institution or TownZ CityItt , Town or Village Of Milton Street Address Gateway House Of Peace in Manner of Death©'Natural Cause O Accident O Homicide O Suicide O Undetermined El Pending htf Circumstances Investigation Ili Medical Certifier Namames North TAM D : AdGrinroad Street Glens Falls, New York 12801 Certific- 4. 1 'Van" Milton Distr g6lumber RegiiOster Number i y, own or i age LJBurial Date 06/29/2016 Cenftery�r Cemat?ry me iew eme e j O Entombment Addss re OCremationueensbury N Y Date Place Removed 9,❑Removal and/or Held and/or E Address Hold . CO O Date Point of — 0 Transportation Shipment G! by Common Destination Carrier O Disinterment Date Cemetery Address O Reinterment Date Cemetery Address Permit Issued to Regan, Denny&Stafford Funeral Home Regbsri�n Number Name of Funeral Home Address.. Quaker Rd. Queensbury, NY 12804 Name of Funeral Firm Making Disposition or to Whom 1 Remains are Shipped, If Other than Above a Address ill _ Permission is hereby granted to dispose of the h . ii •n ins describ abo e as indi 06/27/2016 avr >i Date Issued Registrar of Vital S tistic-411..40 (signature) >' District Number 4561 Place Milton I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 2 ILI Date of Disposition 6/29/201 p,lace of Disposition PineView Ceinetery21 Quaker Rd_ Q Y 2 (address) Erie 3-E 1 CC (section) (lot number) (grave number) ci Name of S on or Person in Charge of Premises Cc nnie L. Goedert ii (please print) Signatu ° ��� ,C � _ Title Cemetery Superintendent (over) DOH-1555 (02/2004)