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Gitto, Jason NEW YORK STATE DEPARTMENT OF HEALTH ' W it i 11 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Jason Anthony Gitto Male Date of Death Age If Veteran of U.S. Armed Forces, . February 26, 2018 45 War or Dates ;£ Place of Death Hospital, Institution or _ City, Town or Village Fort Edward Street Address 64 McCrea Street gi Manner of Death at ❑Natural Cause 0 Accident ❑ Homicide E Suicide ❑ Undetermined X❑ Pending -N.- Circumstances Investigation Medical Certifier Name Title Robert Lemieux, Address 219 Pope Hill Road Argyle, NY 12809 Death Certificate Filed District Number—�� Register Inber City, Town or Village Fort Edward �� ❑Burial Date Cemetery or Crematory March 1, 2018 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held { and/or Address Hold 0 Date Point of & El Transportation Shipment = by Common Destination Carrier ❑ Disinterment Date Cemetery Address ❑ Reinterment Date Cemetery Address Permit Issued to Registration Number a_ Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079 Address 82 Broadway, Fort Edward NY 12828 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address V. Fr, is ere y granted to dispose of the hum ins described abo as indicated. Date Issued goof' Registrar of Vital Statistics 11 /�- (signature) District Number 5'165 Place 66 tu1.'L C dIIu.'aA_d certify that the remains of the decedent identified above were disposed of in accordance with this permit on: to Date of Disposition 03/01/2018 Place of Disposition Quaker Road Queensbury,NY 12804 Z.j (address) w- - (section) / (lot number) (grave number) del Name of Sexton or Person in Charge of Premises bt, l._ St,-'t (lease print) - Signature 6C' Title C1cin (over) DOH-1555 (02/2004)