Trapasso, Joseph NEW YORK STATE DEPARTMENT OF HEALTH # i Z a
Vital Records Section r Burial - Transi Permit
Name First Middle Last Sex
4` '
�,�= Joseph Patrick Trapasso Male
li Date of Death Age If Veteran of U.S. Armed Forces,
December 21, 2011 69 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
' Manner of Death 0 Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
Medical Certifier Name Title
Farhana Kamal, M.D. Dr.
Address
100 Park Street Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village
Date Cemeteryor Crematory
� ❑Burial .
N& December 22, 2011 Pine View
❑Entombment Address
a_*>'®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
{ and/or Address
Hold
wf
Date Point of
-4❑Transportation Shipment
by Common Destination
Carrier
A Date Cemetery Address
i; ❑ Disinterment
1" Date Cemetery Address
❑ Renterment
4 Permit Issued to Registration Number
AT. Name of Funeral Home M. B. Kilmer Funeral Home 01079
-`� Address
82 Broadway, Fort Edward NY 12828
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 t Z/�2/!/ Registrar of Vital Statistics l.A.) CAM-r.q l./•)
(" (signature)
District Number rj (.gyp i Place !, U..)✓`.'S f'(k \\s y Iv V
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 12/22/2011 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot nu per) (grave number)
4.
Name of Sexton or P r on in Charge Premises (r13tci1r eNriFF
rr (please print)
Signature Title rob
(over)
DOH-1555 (02/2004)