Natale, Emilio NEW YORK STATE DEPARTMENT OF HEALTH ' w 4 `
Vital Records Section Burial - Transit Permit
a Name First Middle Last Sex
sue-
Emilio Joseph Natale Male
Date of Death Age If Veteran of U.S. Armed Forces,
A' July 15, 2014 73 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address Westmount Health Facility
Manner of Death 0 Natural Cause El Accident Li Homicide 0 Suicide 0 Undetermined 0 Pending
Circumstances Investigation
Medical Certifier Name Title
Roslyn Socolof, M.D. Dr.
Address
100 Broad Street Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Queensbury S US-1 71.p
0 Burial Date Cemetery or Crematory
,,��` July 16, 2014 Pine View Crematory
0 A Entombment
Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
. by Common Destination
Carrier
to`" Date Cemetery Address
0 Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01078
Address
136 Main Street, South Glens Falls NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
z Date Issued 1 114 I db i4 Registrar of Vital Statistics —1 . (Z , -Lv_-k_ogA,.
(signature)
, District Number C�,s 1 Place Q V cc(1 [-Will
AA I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 07/16/2014 Place of Disposition Quaker Road Queensbury,NY 12804
}I (address)
(section) /1" rot numbe (grave number)
Name of Sexton or Person i Charge of Pr mises f1/�`ti( a C
( lease print)
Signature Title C20916612..
(over)
DOH-1555 (02/2004)