Denno, Reginald NEW YORK STATE DEPARTMENT OF HEALTH # `t (C
Vital Records Section r =i Burial - Transit Permit
1 Name First Middle Last Sex
Reginald L. Denno Male
Date of Death Age If Veteran of U.S. Armed Forces,
August 18, 2011 72 War or Dates
Place of Death Hospital, Institution or
w City, Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death J Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined n Pending
Circumstances Investigation
W Medical Certifier Name Title
CI Joseph C. Mihindu, MD,
Address
20 Murray Street Glens Falls, NY 12801
Death Certificate Filed District Number �� ) Register Number i
Cty, Town or Village f 1
❑Burial Date Cemetery or Crematory
August 23, 2011 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ^ Removal and/or Held
Q u and/or Address
H Hold
CO Date Point of
a. 0 Transportation Shipment
by Common Destination
• Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
III Reinterment
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
1 Remains are Shipped, If Other than Above
2 Address
IX
C' Permission is hereby granted to dispose of the human remains described above as indicated.
z
Date Issued ?)2 // Registrar of Vital Statistics cjti.Q J1�-{ �"
(signature)
District Number 5601 Place 6, (Q)v.5 \\,5, P y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition V/c /ll Place of Disposition gun'Ow 6.0-c`lut Iv--
(address)
11.1
(lot(00
Ce number) (grave
(section) number)
4 Name of Sexton or P on in Charge f Premises 4r` �r Snr44
(please print)
W; L Title CQ c 614AWoL
Signature �r � <
g
(over)
DOH-1555 (02/2004)