Ricciardelli, Allen NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Allen Middle Last Sex
Death
Joseph Ricciardelli Male
Date of
Dea/h Age If Veteran of U.S. Armed Forces,
57 years War or Dates
iiii Place of Death Hospital, Institution or
W City, Tow ' il69(XX Schenectady Street Address Ellis Hospital
WManner of Death❑rtratural Cause 0 Accident ❑Homicide ❑Suicide ❑Undetermined ElPending
0Circumstances Investigation
W Medical Certifier Name Title
p Brian Mc Donald M D
Addrels2s4 Rosa Road, Suite 382, Schenectady, N Y12309
Death CertificateX iled District Number Register3 Number
a
City, To ihayX Schenectady 4601
❑Burial Date Cemetery or Crematory
01/08/2014 Pine View Crematorium
:i 0 Entombment Address
❑Cremation Quaker Rd, Queensbury, N Y
Date Place Removed
Z Removal and/or Held
2 and/or
Address
t Hold
CI)
O Date Point of
❑Transportation Shipment
ci by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home 01078
Address
82 Broadway, Ft Edward, N Y
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
f
In
II` Permission is hereby granted to dispose of the human remain described ,ove asNindic ted.
Date Issued Registrar of Vital Statistics � E, � A, ,,es.i u
6 (signature)
District Number 4601 Place Schenectady
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
LU• Date of Disposition (/ iN Place of Disposition ?NU IiJ CN (;,,`
2 (address)
Ili
IX (section) dr,..>-{efiV,-.
(lot number) (grave number)
Name of Sexton or Person . Charge of Premises --thidil
Z (pleaa print)
Signature ia— Title r' mL
ii
(over)
DOH-1555 (02/2004)