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Lieto, Joseph NEW YORK STATE DEPARTMENT OF HEALTH 70 Vital Records Section Burial - Transit Permit %-„, Name First Middle Last Sex Joseph F. Lieto Male Date of Death Age If Veteran of U.S. Armed Forces, :ar.= January 6,2015 95 War or Dates WWII key. Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death X Natural Cause I I Accident ! i Homicide Suicide ' Undetermined Pending Circumstances Investigation Att Medical Certifier Name Title _0= Suzanne Bergin MD Address :3767 Main Street,Warrensburg,NY 12885 Death Certificate Filed District Number Register Number City, Town or Village C/O Glens Falls 5601 ) I ❑Burial Date Cemetery or Crematory January 8,2015 Pine View Crematory Address ©Cremation 21 Quaker Rd., Queensbury,NY 12804 Date Place Removed Z I I Removal and/or Held and/or Address E Hold N Q Date Point of iiij I 1 Transportation Shipment 'p by Common Destination Carrier Disinterment Date Cemetery Address l I Renterment Date Cemetery Address t,%° Permit Issued to Registration Number Name of Funeral Home Alexander-Baker Funeral Home 00037 Address f='m 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom IRemains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. §.t Date Issued i F 1 j 1,5 Registrar of Vital Statistics (Ack t (signs re) District Number 60 ( Place C/O Glens Falls F I certify that the remains of the decedent identified above were disposed of fffiin accordance with this permit on: W Date of Disposition (/�j /S Place of Disposition 'I�ilr IL Cr -ety(-.., 2 (address) W CC (section) (lot number (grave number) pName of Sexton or Person in Charge of Premises d number).- Z (please pint) W G Title 112E ii 7/Z Signature (over) DOH-1555(02/2004)