Morano, Nicholas d 1 ( `1()
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Nicholas Francis Morano Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 7, 2011 88 War or Dates World War II
Place of Death Hospital, Institution or
City, Town or Village Street Address Mary's Haven
': Manner of Death 0 Natural Cause ID Accident Homicide Ei Suicide n Undetermined Pending
Circumstances Investigation
t J Medical Certifier Name Title
Michael Kolodziej,
Address
400 Patroon Creek Road Alban , NY
Death Certificate Filed District Number Register Numbqr
'Town or Village SARATOGA SPRINGS �� /6,
, �Burial Date Cemetery or Crematory
��
April 8, 2011 Pine View Crematorium
0 Entombment Address
p ®Cremation Quaker Road Queensbury,NY 12804
Removal Date Place Removed
and/or Held
and/or Address
Hold
7 Date Point of
,' ❑Transportation Shipment
a by Common Destination
., Carrier
Disinterment Date Cemetery Address
to Li Reinterment Date Cemetery Address
Permit Issued to Registration Number
a` Name of Funeral Home Carleton Funeral Home, Inc. 00276
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
Remains are Shipped, If Other than Above
' Address
, Permission is hereby granted to dispose of the human rema"Date Issued Myl:boee "ndicate
t.'/r o f, Registrar of Vital Statistics
(signature)
District Number 4L50/ Place SARATOGA SPRINGS
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 4- (ilk Place of Disposition Pia I ,.rtpeli,&
(address)
(section) _ (1 t number) (grave number)
` Name of Sexton or Pers n in Charge of emises / Ask b,- Ji 0t
9
'(please print)
{ Signature .G TM
h g "� Title G h tt10 a
(over)
DOH-1555 (02/2004)