Mormino, Joseph NEW YORK STATE DEPARTMENT OF HEALTH ` k ff Ng
Vital Records Section Burial - Transit Permit
Name First ' Middle Last Sex
Joseph P. Mormino Male
Date of Death Age If Veteran of U.S.Armed Forces,
F February 20, 2016 60 War or Dates
2 Place of Death Hospital, Institution or
W City,Town,or Village Whitehall Street Address Residence
0 Manner of Death 0 Natural Cause 0 Accident Ei Homicide 0 Suicide 0 Undetermined El Pending
W Circumstances Investigation
U Medical Certifier Name Title
W Dr. Bradley Berryhill, M.D. Dr.
0 Address
Castleton Family Health Center, Route 30N, Bomoseen, VT 05732
Death Certificate Filed District Number Register Number
City,Town or Village Whitehall 57c S /
❑Burial Date Cemetery or Crematory
February 24, 2016 Pineview Crematorium
❑Entombment Address
Cremation Quaker Road Queensbury, NY 12804
Date Place Removed
0 Ei Removal and/or Held
- and/or Address
r Hold
0 Date Point of
0 0 Transportation Shipment
i by Common Destination
Caner
Date Cemetery Address
0 �Disinterment
Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
~ Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped, If Other than Above
CZ
W Address
0.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued o?a 3-/4 Registrar of Vital Statistics C�,e 1 �,t/ a {� yed t,t t u
__ (signature)
District Number 61a1$ Place Whitehall,New York
P I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 02/24/2016 Place of Disposition Pineview Crematorium
2 (address)
W
0
0 (section) n�(lot number).. (grave number)
O Name of Sexton or Person in Charge of Premises `'ray r Jtobiat-
WA
(please print)
Signature Title ((LEN I0L,
(over)
DOH-1555 (02/2004)