Piccirillo, Frances 31°
NEW YORK STATE DEPARTMENT OF HEALTH , BUr•i _ Transit Permit
Vital Records Section ,
Name First Middle Last Sex
j:f Frances Helen Picciriillo Female
✓fr Date of Death Age If Veteran of U.S. Armed Forces,
' r May 22, 2016 86 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Wesley Health Care Center
Manner of Death I XI Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
ER Medical Certifier �.—�larrle Ti e
rf r: Address
fir, ��� ' ,v c Yce ccQ E- '6 l u GL 1 C' C I k... --1 1 v� <I2
t:: Death Certificate Filed Disti ct Numbedr J Register N Aber
r: City, Town or Village�a- kidWOK (5 j z❑Burial Date Cemetery or Crematory
May 24, 2016 Pine View Crematorium
❑Entombment Address
Ei Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
O Date Point of
NI I Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Y;f Name of Funeral Home Regan Denny Stafford Funeral Home 01443
:r Address
Jrr 53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
I
Permission is reb granted to dispose of the human remai ribas 'ndicated.
.::: Date Issued /c. ) 2tJ1(.Q Registrar of Vital Statistics
(signature)
::▪ :: Diye. strict Number 4501 Place cpir t S,
I certify that the remains of the decedent identified above were disposed o in accordance with this permit on:
Z
W Date of Disposition 3 J 27lit, Place of Disposition erttLA ( �,�.,
Ill
(address)
U) dct
O (section) (ot number) ( (grave number)
pName of Sexton or Person in Charge of Premises JrZ print)
Wa ...4....Signature Title
(over)
DOH-1555(02/2004)