Amendolia, Salvatore it ifil
NEW YORK STATE DEPARTMENT OF HEALTI-1*-
Vital Records Section ., Burial - Transit Permit
. .
MI Name First
ig--4 Middle Last Sex
Salvatore Domenic Amendolia Male
fER
Date of Death Age If Veteran of U.S.Armed Forces,
in 06/04/2018 70 years War or Dates No
Place of Death -Hospital, Institution or
,...,•'..- City, Town or Village Town Of Corinth Street Address 19 Fill1Pr nr
a Manner of DeathZI Natural Cause 0 Accident 0 Homicide 0 Suicide El Undetermined El Pending
Circumstances I—I Investigation
g Medical Certifier Name Title
:1::.1 Michael Sikinca
6...*: Address
Big 50 Broad St, Waterford, NY 12186
4:41
Death Certificate Filed . . District Number Register Number
14DOW, Town dattilage Corinth 4553 15
...
-.-.• Date Cemetery or Crematory-
..... r_i
U Burial 06/07/2018 Vermont Cremation Services
.-.-.
...-- Address
Cremation Bennington,VT
.:-:. Date - Place Removed
2 El Removal
- and/or Held
;It and/or Address
r;.-- Hold
0 Date Point of
%El Transportation Shipment
a by Common Destination
: : Carrier
Date Cemetery Address
El Disinterment
...
•••'• r--1 Date Cemetery Address
Reinterment
ea Permit Issued to Registration Number
Name of Funeral Home Tunison Funeral Home 01730
Al. Address
105 Lake Ave, Saratoga Springs, NY
Lff Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above Tunison Funeral Home
Address
r, lUb Lake Ave, Saratoga Springs, NY
•,,-.
Permission is hereby granted to dispose of the human r, • -scribe• —ove a--/di
is
re Date Issued 06/06/2018 Registrar of Vital Statistics ,;141--_,„.94. ,,,,, , ,A
9.:
ti (sign. ure)
District Number 4553 • Place Corinth
•
.-.--
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition i•11 il& Place of Disposition 4?..0,...., (1t4Vit4.,••.•
a (address)
igi
(A
CC (section) (lot n9fp bet-) r (grave number)
0 Name of Sexton or Person in Charge of Premises
Ci - Or;tr. ji.....-i,vl
Z
(please print)
441 Signature h...... Title rfur,f4Ft Pd.--
.....
(over)
DOH-1555 (9/98)
. .