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Picioccio, Nicholas B. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Nicholas B. Picioccio I Male Date of Death Age If Veteran of U.S.Armed Forces, 03/24/2020 79 Years War or Dates n or Hospital,Institution Place of Death p W City,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc p Manner of Death ©Natural Cause Accident El Homicide El Suicide Undetermined Pending W Circumstances Investigation U W Medical Certifier Name Title Eric Santell NP Address 131 Lawrence St,Saratoga Springs, New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 188 ❑Burial Date Cemetery,Crematory or Facility Name 03/25/2020 Pine View Crematory Entombment Address ICremation Queensbury Town,New York ❑Donation ORemoval Date Place Removed and/or and/or Held F- Hold Address N G. Date Point of W ❑Transportation Shipment p by Common Carrier Destination El Disinterment Date Cemetery Address El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address Q W t1 Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/26/2020 Registrar of Vital Statistics John Paul Franck(Electronically Signed) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition �;Z7:;VZp Place of Disposition } ` �� 1f1e,v ss/ 2 W N (section) (lot numbRrl (grave number) Name of Sexton or Person in Ch a of Pr es D✓,%l Ov /please print/ W Signature Title DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013474 Receipt Human remains of delivered on , 20 i Pine View Cemetery Representing the funeral home named on burial permit . Official Funeral Directors Reg.or License#