Festa, Eugenio NEW YORK STATE DEPARTMENT OF HEALTH , i
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Eugenio Festa Male
Date of Death Age 1 If Veteran of U.S. Armed Forces,
November 15,2012 73 War or Dates
F.. Place of Death Hospital, Institution or
Z City, Town or Village North Elba Street Address 323 Whiteface Inn Lane
p Manner of Death C Natural Cause [1 Accident ❑Homicide ❑Suicide n Undetermined U Pending
ui Circumstances Investigation
W Medical Certifier Name Title
CI George S.Cook M.D.
Address
309 CR 47,Saranac Lake,NY 12983
Death Certificate Filed District Number Register Number
City,Town or Village North Elba 1560 I
❑Burial Date Cemetery or Crematory
❑Entombment November 19,2012 Pine View Crematory
Address
®Cremation 21 Quaker Rd., Queensbury,NY 12804
Date ' Place Removed
Z
❑Removal I and/or Held
and/or Address
E Hold
V)
O Date Point of
N U Transportation Shipment
p by Common Destination
Carrier F
Disinterment Date Cemetery Address
ni Reinterment Date Cemetery Address •
Permit Issued to Registration Number
Name of Funeral Home M.B. Clark,Inc. 01075
Address
2310 Saranac Ave.,Lake Placid,NY 12946
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped, If Other than Above
2 Address
W
U. Permission is hereby granted to dispose of the human re .ins descri ed above as indicated.
/ ii /'�
Date issued //—J — 2 /. Registrar of Vital Statistics iI�(./ ,�Ci
(signature)
District Number 1560 Place North Elba
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tuDate of Disposition II-j1-0_ Place of Disposition et.i.,(k...) i�r, o ft i,_(address)
W
CO
Or (section) Ae (lot number) (grave number)
pName of Sexton or Person in Char of Premises n, .r`Ar(3'
Z V (please print)
W
Signature61-, — Title ea fli K�Q,
(over)
DOH-1555(02/2004)