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Mirasola Jr., Joseph t . NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Joseph Mirasola Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 12/16/2017 89 Years War or Dates 1945-1949 A"_ Place of Death Hospital, Institution or I City, Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Daniel Larson MD Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed • District Number Register Number City,Town or Village Fort Edward 5755 62 Muria' Date Cemetery or Crematory 12/19/2017 Pine View Crematory w El Entombment Address®Cremation Queensbury, New York Date Place Removed ❑Removal and/or Held 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 Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 I. 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 12/19/2017 Registrar of Vital Statistics Aimee9Kanoncy fEi<ctrunicaaySigned' (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition /yZi`,7 Place of Disposition P,2 A...,r('... .O,,,-„ �y " ? / (address) (section) (lot nu ber) (grave number) Name of Sexton or Person ' Charge of Premises v w 1 I a el C,741 r11 le (please print) Signaturei4_, GvTitle � n� (over) DOH-1555(02/2004)