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Fiorillo Sr., John Joseph A Z99 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last John Joseph Fiorillo Sr. 7mx ale Date of Death Age If Veteran of U.S.Armed Forces, 03/31/2020 88 Years War or Dates 1952-1953 Place of Death Hospital,Institution or City,Town or Village Glens Falls Street Address Glens Falls Hospital Uj p Manner of Death © Natural Cause Accident Homicide Suicide Undetermined Pending UJ Circumstances Investigation U W Medical Certifier Name Title Mary Stein NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 148 ❑Burial Date Cemetery,Crematory or Facility Name 04/01/2020 Pine View Crematory ❑Entombment Address Cremation Queensbury Town,New York Donation Z Removal Date Place Removed F= and/or and/or Held Hold Address IL Date Point of to ❑Transportation Shipment Gl 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-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above a Address W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/01/2020 Registrar of Vital Statistics g?,96ertAndrew Curtis(ECectronicaffy Signed (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: Date of Disposition q 17,110 Place of Disposition I (lu_ Uj (address) W' U /section) (lot number) (grave number) Name of Sexton or Person in Charge of P ises �t (ple se print z W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013502 r � Receipt i Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#