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Cardinale, Vincent James # 130 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Vincent James Cardinale Date of Death Age If Veteran of U.S.Armed Forces, 02/07/2020 85 Years War or Dates 1957-1957 Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation LU a Mannerof Death g © Natural Cause 1:1Accident ❑Homicide 1:1Suicide ❑Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title 13 Gwendolyn Morris-Dickinson PA Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 66 ❑Burial Date Cemetery,Crematory or Facility Name 02/10/2020 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation Z Date Place Removed F-]Removal and/or and/or Held l`N Hold Address O a Date Point of N Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom f.. Remains are Shipped,If Other than Above Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/10/2020 Registrar of Vital Statistics (RgbertAmlrew Curtis(ECectronicalTySigned) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition 2 f to�7b Place of Disposition i r M (address/ W N (section) (lot number (grave number) M 0 Name of Sexton or Person in Char�of Premises Mleas tl lL Signature Title " DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20_ i Pine View Cemetery Representing the funeral home named on burial permi Official Funeral Directors Reg.or License#