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Colontuono, Joseph NEW YORK STATE DEPARTMENT OF HEALTH f- il C t Vital Records Section Burial - Tr ansi Permit Name First Middle Last Sex os-eph A Cd 1 oy- fuono Maie, Date of Death Age If Veteran of U.S. Armed Forces, I I _ / ZO/CP gin War or Dates ) Q 5/ -/957 I-, Place of Death Hospital, Institutio or City, Town or Village G i�5 f a 1 is Street Address c� f-a l k Nos p n a p Manner of Death F Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending LEI Circumstances Investigation ui Medical Certifier Name Title o J0.rnes N©r M 1> Address /n o 8road 5t G/015 is6 NY /2801 Death Certificate Filed/— District Number Register Nu ber Cit Town or Village /CMS f L f is 5'600 / L-5- / ❑Burial Date Cemetery o Crematory ❑Entombment 1 1— l Y -l Cv ' _ r e vie e co C"rel'w Address ;`'12Cremation GL O—L )5 bud-24 AY Date ✓I Placd Removed Z Removal and/or Held 2❑and/or Adc E. Hold Lt 0 Date Point of E Transportation , Shipment a by Common Destination Carrier ❑Disinterment Date I Cemetery Address • : ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home 3 j'aL)-er P... j /4-0/T /17 C.. OO -// Address Church V L&k L u Zz/' , Ay /a g% Name of Funeral Firm Making Disposition or to Whom 1-. Remains are Shipped, If Other than Above 2 Address Ir LEI CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11 , ( Li' I I. Registrar of Vital Statistics 1 c, &.p- (signatur District Number bo p t Place C��y P 610)5 raj/6 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: t D 10 Date of Disposition il/J6 4Place of Disposition ? 1114 C644 I> 2 (address) ill CC (section) (lot nnumber) (grave number) 1 Name of Sexton or Person in Charge of Premises ��r,si -t^,0� Z pp'� (please print) LEl Signature GrL Title t floe((DPL (over) DOH-1555 (02/2004)