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Caputo, Charles Henry
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Charles Henry Caputo Male Date of Death Age If Veteran of U.S.Armed Forces, 03/20/2020 80 Years War or Dates Vietnam Place of Death Hospital,Institution or City,Town or Village Kingsbury Town Street Address 3686 Burgoyne Avenue,Kingsbury Town,New York 12839 Manner of Death ©Natural Cause Accident Homicide EjSuicide ❑Undetermined Ej Pending Circumstances Investigation Medical Certifier Name Title Wesley Perry Coroner Address 415 Lower Main Street,Hudson Falls,New York 12839 Death Certificate Filed District Number Register Number n City,Town or Villa a Kingsbury Town 5762 7 Burial Date Cemetery,Crematory or Facility Name 03/24,12020 Pine View Crematory Entombment Address z*t` X❑Cremation Queensbury Town,New York a; Donation fiRemoval Date Place Removed and/or and/or Held 05 Hold Address 1V Date Point of ❑Transportation Q by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number 'r Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 rs. 4; Address I` 82 Broadway,Fort Edward,New York 12828 *; Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address M W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/24/2020 Registrar of Vital Statistics Cynthia Bardin(ECectronicalCySigned) (signature) {' District Number 5762 Place Kingsbury Town, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition s_ 7,, Place of Disposition 6Rje ti (addr (section) (lot number/ (grave number) Name of Sexton or Person i Charge/Pm ises .✓ ` � (P e print) Signature / Title C W. DOH-1555(o7/18)p 1 of 2 a- r Public Health Law Sec. 4145(2b) 0.1 3 4 5 4- Receipt Human remains of delivered on T' T , 20 r r r 1` ?_. _ Pine�'iew Cemetery R p esenting the funeral home named on burial permit Official Funeral Directors Reg.or License# ;