Cocca, Cosimo NEW YORK STATE DEPARTMENT OF HEALTH , it r
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Vital Records Section S�.Irial Tran it Permit
%% Name First Middle Last Sex
Cosimo M. Cocca Male
Date of Death Age ' If Veteran of U.S. Armed Forces,
March 6, 2013 83 War or Dates
Place of Death Hospital, Institution or
City Town or Village Glens Falls , Street Address Glens Falls Hospital
Manner of Death Natural Cause + 'Accident n Homicide Suicide 1 Undetermined J Pending
14
Circumstances Investigation
M cal Certifier Name Title
`' •Address i
i Death Certificate Filed District Number Register Number
City, Town or Village Glens s 5601 9(/
❑Burial Date Cemetery or Crematory
March 11 2013 Pine View Crematorium
❑Entombment Address ,
CI Cremation 21 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
I Hold
N
0 Date Point of
N n Transportation Shipment
a by Common Destination
Carrier
n Disinterment Date Cemetery Address
Date Cemetery Address
1-1 Reinterment
': 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 remains des r''bee ab e a1 icated.
Date Issued 0,3/O /2 3 Registrar of Vital Statistics .'
(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:
Z �
Ill Date of Disposition ,--// -73 Place of Disposition ;/-'i Ne_k.-r .
W (address)
ca
0 (section) Apt (grave number)
Name of Sexton oerson inge of Premises yt
Z (please print)
Signature / Title /e4,.. 451
(over)
DOH-1555(02/2004)