Fiore, Joseph 17
NEW YORK STATE DEPARTMENT OF HEALTH a 37`6
Vital Records section 0- Burial - Transit Permit
Name First Middle Last Sr
,kos �Q Q�,�.�ALE FlOiLE.
in Date of each Age 1 If Veteran of U.S. Armed Forces,
�a I-O is Q a War or Dates 3L.-)L T
.144.:... Place of Death Hospital, Institution or
City, Town or Village oLO - I. C 1 Street Address Q .. AN`c Coot-sT*1 N-\v1-S/ v 1'6(4
Manner of Death Natural Cause 0 Accident ❑Homicide ❑Suicide El Undetermined ri Pending
VA Circumstances Investigation
la Medical Certifierlti Name Title
Address
__ ALN,Al,sy Covt.S-Tk IvL 42--SjNC. (A
:: Death Certificate Filed i District Number Register umber
ai
mg City, Town or Village j /'-j /O()
Date Cemetery or Crematory
❑Burial .5-Ai iao IS qi a C \)t t_\..) Lus_. rt-vo Ce.2-1
nn 11z Address
I Cremation c. v A:.L�R V,.: avE. C N s t3 vim'-, N1 l r1e0 4
Date 1 Place Removed
0❑Removal 1 and/or Held
•— and/or Address
= Hold
0 Date —Point of
Q Transportation j Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
::_:. ❑Reinterment Date Cemetery Address
11111111111 Permit Issued to Registration Number
11 Name of Funeral HomE 'Baker FUlleral //ome, of l �o
1. Address
// LaFa-t-le tte (31-. , bu.k cnsbc,t-ny 1 jUe w Lio• cx l a 2 Ol
go Name of Funeral Firm Making Disposition or to Whom
II. Remains are Shipped, If Other than Above
14 Address
114
IX
€: Permission is hereby ranted to dispose of the human r " s described ab ve as ind"cated.
a Date Issued 5 ZO/SRegistrar of Vital Statistics ( 6.
ignature)
''` District Number / 5 5 Place . T U v(,l/\/ F (_-C1I//
iia
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
II
E Date of Disposition S 1 1)1 c Place of Disposition £1J.... 6-141l,,,.,
W (address)
U3
it (section) t nmb ) (grave number)
Name of Sexton or Person in Charge of Premises f,, u4,6u' ,
Z / (please print) J
W Signature G'� Title (If 01i1FAC
(over)
DOH-1555 (9/98)