Loperfido, Benny it L(L
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Benny D Loperfido Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 14, 2014 86 War or Dates Korean
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
g Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
g Medical Certifier Name Title
gi Marvin Davidowitz
Address
GFH, 100 Park Street,Glens Falls,NY 12801
:: Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 3-i 1
❑Burial Date Cemetery or Crematory
July 17, 2014 Pine View Crematorium
❑Entombment Address
❑x Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
2 and/or Address
H Hold
N
0 Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 12804
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 mains de cribed ab e as indi ate .
Date Issued o///(e/ )J ye Registrar of Vital Statistics O'—e-e-t [%2'"e
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
fr,,,k, fu�._
W �Date of Disposition '1''►-��! Place of Disposition
2 (address)
W
U)
Q: (section) �r(loJ number) (grave number)
QName of Sexton or Person in Charge of remises , S144
'it
Z I (p/else print)
Signature Title Cat--PAIR
(over)
DOH-1555(02/2004)