Finocchio, Cosmo -iVn&
NEW YORK STATE DEPARTMENT OF HEAL 2-7 `
Vital Records Section Burial - Transit Permit
:; Name First Middle Last Sex
` :: Cosmo S Finocchio Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 26, 2014 44 War or Dates
°� Place of Death
i Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death I XI Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
r�>
Medical Certifier Name Title
Suzanne Rayeski Dr.
::. 2, Address
':,. 3767 Main Street,Warrensburg,NY 12885
' :r Death Certificate Filed District Number:1 Registgr Nupber
City, Town or Village Glens Falls 5601 '�
❑Burial Date Cemetery or Crematory
Entombment April 30, 2014 Pine View Crematory
Address
❑x Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F Hold
N
O Date Point of
cTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
rv� Permit Issued to Registration Number
tx
:. Name of Funeral Home Regan Denny Stafford Funeral Home 01443
ir; Address
::ra: 53 Quaker Road, Queensbury, NY 12804
'::::r Name of Funeral Firm Making Disposition or to Whom
it Remains are Shipped, If Other than Above
Address
r
ram.• Permission is hereby granted to dispose of the human remains described above as indicated.
x-:: Date Issued `i l ''..-(Ni1!L/ Registrar of Vital Statistics w (-0
'-.?:: (s gnature)
c:;• � 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:
w Date of Disposition q-30-11,1 Place of Disposition awN %t) CV/01 f
2 (address)
W
U)
g (section) (lot (grave number)
ca• Name of Sexton or erson in Charge of Premises
Z /��`�(please print)
W C 14 Signature Title ittp I kS_C _
(over)
DOH-1555(02/2004)