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Diaz, Gilberto
NEWYORK STATE DEPARTMENT OF HEALTH Burla� - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gilberto Diaz Male Date of Death Age If Veteran of U.S.Armed Forces, 04/15/2020 81 Years War or Dates j,� Place of Death Hospital,Institution or 2 City,Town or Village Glens Falls Street Address Glens Falls Hospital LU Mannerof Death ©Natural Cause Accident Homicide Suicide ❑Undetermined Pending Circumstances Investigation Medical Certifier Name Title Marvin Davidowitz MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 15601 178 Burial Date Cemetery,Crematory or Facility Name 04/17/2020 Pine View Crematory ❑Entombment Address Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held ,„+ Hold Address O Transportation Date Point of p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment 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 Remains are Shipped,If Other than Above 2 Address lIX W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/17/2020 Registrar of Vital Statistics &bertAndrew Curtis(ElectronicaQySigned) (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: Zrr N � Date of Disposition ��1'2D Place of Disposition l (address) �l (section) (!ot number/ (grave number/ Qt.t Name of Sexton or Person in Charge of Premises h--tl (p/ se print W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 1.. 7 L) 1 Receipt 1 : 1 Human remains of ( '" delivered on• , 20 X' Pine View Cemetery Representing the"fuderal home named on bu_rial.permit Official Funeral Directors Reg.or License#