Cardinale, Joseph tt
NEW YORK STATE DEPARTMENT OF HEALTH r 111 68
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
'7> Joseph Cardinale Male
=t Date of Death Age If Veteran of U.S. Armed Forces,
February 28,2014 61 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 500 Upper Sherman Ave
Manner of Death Natural Cause 7 Accident n Homicide n Suicide n n Undetermined Pending
Circumstances Investigation
'" Medical Certifier
1Name Title
X Darci Gaiotti Grubbs Dr.
Address
4 102 Park St, Glens Falls,NY 12801
} Death Certificate Filed District Number Re,giste umber
A City, Town or Village 9 Queensbury 5657
El Burial Date Cemetery or Crematory
March 4, 2014 Pine View Crematorium
❑Entombment Address
❑x Cremation 21 Quaker Road, Queensbury,NY 12804
Date Place Removed
ZO n Removal and/or Held
and/or Address
H Hold
N
O —
Date Point of
N Transportation Shipment
p by Common Destination
Carrier
U Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
f' Address
407 Bay Road, Queensbury, NY 12804
y Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
b
k s
Ws
'f%.a Permission is hereby granted to dispose of the human remains described Bove ns indicated.
f t
3Y�; Date Issued �1o)0 i Li Registrar of Vital Statistics -KC\ LA,a �_
- (signature)
• District Number 5657 Place Queensbury
f
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition s/3j Id Place of Disposition tL (- ,ff.,-.
2 3/��)� (address)
W
Ce (section) (lot number) (grave number)
00 Name of Sexton or Person in Charge of P mises n S:ni,iii
W 1/7
(ple se print)
Signature - Title Ceift41 j2
(over)
DOH-1555(02/2004)