Fagnano, Aaron NEW YORK STATE DEPARTMENT OF HEALTH j #0?
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Aaron Fagnano Male
Date of Death Age If Veteran of U.S. Armed Forces,
March 7, 2016 42 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X❑ Natural Cause IIIAccident ElHomicide ❑ Suicide ❑ Undetermined ri❑ Pending
Circumstances Investigation
Medical Certifier Name Title
Mathew Varughese, M.D. Dr.
Address
100 Park Street Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls D eo ) 12 I
❑Burial Date Cemetery or Crematory
March 9, 2016 Pine View Crematory
❑Entombment
Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
anoldd/or Address
H
Date Point of
a. ❑Transportation Shipment
by Common Destination
Carrier
❑ Disinterment Date Cemetery Address
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078
Address
136 Main Street, South Glens Falls NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
'' Address
i
Permission is hereby granted to dispose of the huma remain escribed above as Indic. =d.
Date Issued 0 G Registrar of Vital Statistics 227 Of'`--�_
(signature)
District Number &G / PlaceAf-ea— ) 7 L7
I certify that the remains of the decedent identified above were disposed of in accordance ith this permit on:
Date of Disposition 03/09/2016 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) 0 (lot number (grave number)
a Name of Sexton or Person in Charge f Premises an itigtf!'
lease print)
f Signature a Title ar-fAliAt
T
(over)
DOH-1555 (02/2004)