Rodriguez, Joseph v
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
JOSEPH RODRIGUEZ Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 12,,2017 78 War or Dates
Place of Death Hospital, Institution or
City, Town or Village GLens Falls, ;QY Street Address Glens Falls Hospital
0 Manner of Death gXl Natural Cause ❑Accident ❑Homicide Suicide 0 Undetermined O Pending
t✓f Circumstances Investigation
tu Medical Certifier Name Title
O
Address
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls,,NY 5601
s Curial Date Cemetery or Crematory
❑Entombment April 18,,2017 Pine View Cemetery
Address
❑Cremation Quaker Road,,Queensbury,,NY
Date Place Removed
Removal and/or Held
... and/or Address
Hold
U
O Date Point of
tip
Transportation Shipment
Q by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford D1443
Address
Quaker ROad Queensbury„NY 12804
Oi Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
;'; Address
ot
Ili
CL
Permission is hereby granted to dispose of the human remains des ribe ab ven icated.
IiHipl Date Issued 4/16/1017 Registrar of Vital Statistics G r
(signature)
District Number 5-60/ Place City of Glens Falls, ,NY 12801
I certify that the remains of the decedent identified above were isposed of'in a rdance with this permit on:
lit• Date of Disposition �//�'/0- Place of Disposition 2/ Mu/c/. !tt/4449021
2 (address)
Ul hie �/- /
cc (secti (lot number) (grave number)
a
CI Name of ton or Person in Charge of Premises (9�1u i� L. �6,DQ
. 447 (
print)
&gnat f `�'`Y(U TitlEater-04y ---. . ,e2-11-.Q1--rr
(over)
DOH-1555 (02/2004)