Martucci, James NEW YORK STATE DEPARTMENT OF HEALTH t.Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Janes Vincent Martucci male
ia Date of Death Age If Veteran of U.S. Armed Forces,
10/10/2013 86 War or Dates US ARMY Korea
154, Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
lijManner of Death®Natural Cause Accident Homicide Suicide Undetermined Pending
lira Circumstances Investigation
Medical Certifier Name Title
Joseph Mihindo MD
Address
Glens Falls New York
Death Certificate Filed District Number Register Number
ei City, Town or Village Glens Falls _5 6 0 i y 2.5
El Burial Date Cemetery or Crematory
10/11/2013 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York
Date Place Removed
Removal and/or Held
0,0 and/or Address
i= Hold
ta
t? Date Point of
lia Transportation Shipment
d by Common Destination
1114 Carrier
El Disinterment Date • Cemetery Address
Q Reinterment Date Cemetery Address
gii
iiigii Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Wi
Address
5.3 Quaker Rd. Queensbury, NY 12804
lilllii Name of Funeral Firm Making Disposition or to Whom
104 Remains are Shipped, If Other than Above
2 Address
W.
` Permission is hereby granted to dispose of the human remains described above as iiidicated.
Date Issued 10/11/2013 Registrar of Vital Statistics (A-) C J � l./�)
(signature)
gi District Number s'60 I Place 6 L r s cx ( s,N y 1 ae0 1
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k
ill Date of Disposition Jo//-0 Place of Disposition P tve.. V&,.,, eelopel,.rh/
2 (address)
111
CC (section) Aot nu ber) (grave number)
Name of Sexton r Perso arge of Premises SCO „C(
2 I (please print)
Signature Ct Title O-ter/A r C )
(over)
DOH-1555 (02/2004)