Trunzi, Vincenzo NEW YORK STATE DEPARTMENT OF HEALTH
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Vital Records Section Burial - Transit Permit
w Name First Middle Last Sex
Vincenzo Trunzi Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 7, 2014 86 War or Dates
: Place of Death Hospital, Institution or
-, City, Town or Village Argyle Street Address Pleasant Valley
11
Manner of Death Fri
Exi Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
'„i Medical Certifier Name Title
Address
ice-
• Death Certificate Filed District Number ; __ Register Number
City, Town or Village Argyle J 1 .-
:• ;❑Burial Date Cemetery or Crematory
January 8, 2014 Pine View Crematory
i_l. ❑Entombment Address
4®Cremation Quaker Road Queensbury,NY 12804
-,❑ Removal and/or Held
Date Place Removed
and/or
Hold Address
Date Point of
❑Transportation Shipment
by Common Destination
ot Carrier
❑ Disinterment Date Cemetery Address
., ❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home 01079
Address
7 4 82 Broadway, Fort Edward NY 12828
Name of Funeral Firm Making Disposition or to Whom
`'�' Remains are Shipped, If Other than Above
w` Address
4
• Permission is hereby granted to dispose of the human._ mains describe above as indicated.
Date Issued \ ,�� Registrar of Vital Statistics 1 , \ 1 above as
(signature)
District Number J.\`jC) Place (k {c
• I certify that the remains of the decedent identi ie above were disposed of in accordance with this permit on:
Date of Disposition 01/08/2014 Place of Disposition Quaker Road Queensbury,NY 12804
I: (address)
k (section) ,p(Ipt number) r (grave number)
Name of Sexton or Person in �.-harge of remises net L" PwL T
/ (phase print)
Signature G Title O N"
(over)
DOH-1555 (02/2004)