Caggiano, Rocco Ft
NEW YORK STATE DEPARTMENT OF HEALTH ., - p B -�
Vital Records Section urial - Transit Permit
r Name First Middle Last Sex
Rocco Caggiano Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 13, 2013 70 War or Dates
F' Place of Death Hospital, Institution or
W City, Town or Village Kingsbury Street Address 423 Town Line Road
Manner of Death LI] Natural Cause 0 Accident ID Homicide Suicide Undetermined Pending
UJ
C3
' Circumstances Investigation
Medical Certifier Name Title
CI Max Grossman MD,
Address
North St. Granville, NY 12832
Death Certificate Filed District Number Register Number
City, Town or Village 576 a o I
0 Burial Date Cemetery or Crematory
January 16, 2013 Pine View Crematorium
0 Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z 0 Removal and/or Held
and/or Address
E Hold
e6 Date Point of
Transportation Shipment
O) by Common Destination
l _ Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
2 Address
iti:
C.L. Permission is hereby granted to dispose of the human re 'ns escribed above as indicated.
Date Issued it-- /6 _/3 Registrar of Vital Statistics -- l' —cs • -
(signature)
District Number 576 a Place �eruu /
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
It—
Z Date of Disposition p p �-51(-c� Place of Disposition +ni rc.,. rtrrsfar:40--
W (address)
GO
✓ (section) (lot number) (grave number)
O (l0 Name of Sexton or Person in Charge of remises r3�yi--- �N�
(pl ase print)
LU Signature Title C ,i41A-
(over)
DOH-1555 (02/2004)