Nigro Jr, Michael NEW YORK STATE DEPARTMENT OF HEALTH 661
Vital Records Section t . , Burial - Transit Permit
Name First Middle Last Sex
Michael Nigro Jr Male
Date of Death Age If Veteran of U.S. Armed Forces,
12/25/2012 R1 years War or Dates Army
t Place of Death Hospital, Institution or
IZ City, To tigti) Street Address
t �'�j`X X Glens Falls Glens Falls Hospital
ri Manner o- eat &](Natural Cause ❑Accident ❑Homicide ❑Suicide 0 Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
Q Joseph C Mihinda M D
Address
20 Murray Street Glens Falls, N Y 12801
Death Certificate Filed District Number Register Number
City, TowVillestxX Glens Falls sAn1 598
CI Burial Date Cemetery or Crematory
['Entombment 12/31/2012 Pine View Crematnriiim
Address
}JCjemation Oueenshury, NY 12804
Date Place Removed
Z Removal and/or Held
01-1
and/or Address
CO Hold
0 Date Point of
N ❑Transportation Shipment
G by Common Destination .
Carrier
•Date Cemetery Address
❑Disinterment
❑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
1 Remains are Shipped, If Other than Above
2 Address
0
LU
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/28/2012 Registrar of Vital Statistics tA-3
signaturev )
District Number Place
561)1 Glens Falls; V
" I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
t
la Date of Disposition I--3-4 Place of Disposition •P,4,0,w, C to r►in-.-
a „ I,� (address)
tO
CC (section) (lot number) (grave number)
a 5-
0 Name of Sexton or Person in Charge of Premises r� chti
lease print)
,,i._____
Signature - Title Gel +''+9TOit
(over)
DOH-1555 (02/2004)