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Berkowitz, Kevin NEW YORK STATE DEPARTMENT OF HEALTH ` • 1 / Vital Records Section Burial - Transit Permit N• ame First Middle Last Sex Kevin M Berkowitz Male .<;< Date of Death��f; Age If Veteran of U.S. Armed Forces, J• anuary 16,2013 60 War or Dates fri' Place of Death Hospital, Institution or - City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death IX!Natural Cause ❑Accident fl Homicide pi Suicide ❑Undetermined n Pending Circumstances Investigation � Medical Certifier Name Title Aged Gilianni,MD Address 102 Park Street,Glens Falls,NY 12801 0 D• eath Certificate Filed District Number Register F4un _er `' City, Town or Village Glens Falls 5601 ❑Burial Date Cemetery or Crematory January 22, 2013 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road, Queensbury, NY 12804 Date Place Removed ZZ ❑Removal and/or Held and/or Address 1 Hold N O Date Point of O. Transportation Shipment a by Common Destination Carrier ❑Disinterment Date Cemetery Address El Reinterment Date Cemetery Address ''e" Permit Issued to Registration Number Name of Funeral Home Regan& Denny Stafford Funeral Home 01443 Address 53 Quaker Road,Queensbury, NY 12804 "f. Name of Funeral Firm Making Disposition or to Whom R• emains are Shipped, If Other than Above Address > ' Permission is he eb granted to dispose of the human mains ascribed bove as in . • , Date Issued f)� /J ['. Registrar of Vital Statistics �� ��, C (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 tu Date of Disposition 1-23-i3 Place of Disposition „4U,,1(44) Ccinctotiu., Ili (address) U) O (section) At (lot number) (grave number) QName of Sexton or Person in Charge ofPremises I .Qroil' Z Y(please print) LU 4fSignature L Title r R 9 r}(,d (over) DOH-1555(02/2004)