Orlando, Thomas NEW YORK STATE DEPARTMENT OF HEALTH • 313
Vital Records Section Burial - Transit Permit
. Name First Middle Last Sex
Thomas A. Orlando Male
Date of Death Age If Veteran of U.S. Armed Forces,
j`.; April 16,2017 77 War or Dates 1962-1962
Place of Death Hospital, Institution or
, City, Town or Village Town of Moreau, NY Street Address 9 Amber Lane,Fort Edward,NY
;;-w Manner of Death n Natural Cause n Accident n Homicide n Suicide n Undetermined n Pending
Circumstances Investigation
Medical Certifier Name Title Joanne Cooper PA
Address
48 E. Street Fort Edward,NY 12828
Death Certificate Filed District Number Register Number
City, Town or Village Town of Moreau, NY V5la. a /
❑Burial Date Cemetery or Crematory
❑Entombment April 21, 2017 Pine View Crematorium
Address
❑X Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
ZZ'n Removal and/or Held
and/or Address
Hold
Cl)
0 Date Point of
O.
n Transportation Shipment
p by Common Destination
Carrier
n Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan& Denny Funeral Home 01444
Address
• 94 Saratoga Avenue, South Glens Falls,NY 12803
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 Lj/, c'/!`7 Registrar of Vital Statistics ' - .21/ '-e>
(signature)
District Number G Place %Z -J.'i c r 40.0 e aGL
I certify that the remains(of the decedent identified above were disposed of in accordance with this permit on:
Z p c�l yt9�7Disposition 't A . VIA /
Date of Disposition Z Place of ► „J �N '�or
LL (address)
U)
Lt
(section) /�/(lot number) (grave number)
Z' Name of Sexton or Person in Charge of P mises i r �r i el
Z ILI
/, (pl�se print)
Signature C;l Title (Urine
(�e
(over)
DOH-1555(02/2004)