Palmieri, Benjamin NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section f Burial - Transit Permit
Name First Middle ` Last Sex
Benjamin Palmieri Male
Date of Death Age - If Veteran of U.S.Armed Forces,
1, December 8, 2014 81 War or Dates Korean Conflict 1951-1954
Z Place of Death Hospital, Institution or
W City,Town,or Village Glens Falls Street Address Glens Falls Hospital
G Manner of Death x❑Natural Cause ❑ Accident ❑Homicide ❑Suicide ❑Undetermined ❑ Pending
W Circumstances Investigation
0 Medical Certifier Name Title
W Agee! Gilliani MD
a Address
102 Park Street, Glens Falls, New York 12801
Death Certificate Filed District Number Register Number
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City,Town or Village Glens Falls /
❑Burial Date Cemetery or Crematory
December 15, 2014 Pineview Crematory
❑Entombment Address
z El Cremation Queensbury, New York
Date Place Removed •
a ❑Removal and/or Held
- and/or Address
I' Hold
0 Date Point of
a ❑Transportation Shipment
Ili by Common Destination
Carrier
Date Cemetery Address
6 ❑Disinterment
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
F= Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped, If Other than Above
IX
W Address
0.
Permission is hereby granted to dispose of the human re sins described ab�ve as indicat .
Date Issued a f babay Registrar of Vital Statistics /7 d&7, "21—<--
(signature)
District Number Of Place Glens Falls,New Yor
• I certify that the remains of the decedent identified above were dispo ed of in accordance with this permit on:
W Date of Disposition ill Is-11 Place of Disposition m L 644t _
2 (address)
W
if
(section) (lot number) � (grave number)
0• Name of Sexton or Person in Charge of Premises il.r, at poit
W (please pn
Signature Title nl oiretr
(over)
DOH-1555 (02/2004)