Cardini, Charles c st
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
is Name First Middle Last Sex
Charles J. Cardini Male
Date of Death Age If Veteran of U.S. Armed Forces,
IA / 21 / 2016 73 War or Dates N/A
14 Place of Death Hospital, Institution or
2 City, Town or Village Wilton Street Address 16 Castleberry Dr.
C Manner of Death E Natural Cause El Accident 0 Homicide 0 Suicide 0 Undetermined 0 Pending
Ili Circumstances Investigation
ill Medical Certifier Name Title
its Michael Sikirica MD
Ni Address
50 Broad St, Waterford, NY 12188
Death Certificate Filed District Number Regist r Number
City, Town or Village Wilton
z< < Burial DateCemetery or CremYq9
ry
11 / 23 / 2016 Pine View Crematory
u Entombment Address
">EJ4. Cremation Queensbury, NY
Date Place Removed
❑Removal , and/or Held
r and/or Address
i Hold
0 Date Point of
ti 0 Transportation Shipment
d by Common Destination
Carrier
El Disinterment Date Cemetery Address
iMi
Q Reinterment Date Cemetery Address
Permit Issued to ! Registration Number
ligii Name of Funeral Home Compassionate Funeral Care 00364
>[ Address
''3 402 Maple Ave., Saratoga Sp. , NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Z. Address
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Permission is hereby granted to dispose of the human remains described above as indiiccated.
< Date Issued ? Registrar of Vital Statistics /1t71 ,//�
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'; District Number Place Wilton , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Iiio
ill Date of Disposition lilL8//6 Place of Disposition 4141: Crno.440r,—
i (address)
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0
cr (section) of number) (grave number)
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0 Name of Sexton or Person ip Charge of Premises IA kl P.- ..StiA ii
Z / (plea a print) .
Signature 1 e� Title a(t fw it Fe
VV (over)
DOH-1555 (02/2004)