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Costantion Jr., Gerald NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex • Gerald Costantino Jr. Male '`' Date of Death Age If Veteran of U.S.Armed Forces, 08/03/2018 66 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Saratoga springs Street Address Saratoga Hospital § Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation - Medical Certifier Name Title Todd Duthaler DO Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City, Town or Village Saratoga Springs 4501 433 ❑Burial Date Cemetery or Crematory 08/08/2018 Pineview Crematorium El Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held is and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 • Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/05/2018 Registrar of Vital Statistics yohn P Franck(E(ectronua1TySigned) (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: Date of Disposition 9 j')I? Place of Disposition 11•IL. ir"'tmv (address) (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises print)! SINAI (please print • Signature ._ 14-1I Title 11rJhhTolL (over) DOH-1555(02/2004)