Record, Vincent Santino NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Vincent Santino Record Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/19/2020 32 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Hudson Falls Village Street Address 78 Maple Street, Hudson Falls Village, New York 12839
Manner of Death ❑Natural Cause ❑Accident ❑Homicide ❑Suicide El Undetermined Pending
Circumstances Investigation
WMedical Certifier Name Title
Robert Lemieux Coroner
Address
415 Lower Main Street,Hudson Falls Village,New York 12839
Death Certificate Filed Dist t t Number Register Number
City,Town or Village Hudson Falls Village 35
Burial Date Cemetery,Crematory or Facility Name
10/27/2020 Pine View Crematorium
❑Entombment Address
X❑Cremation Queensbury Town,New York
▪Donation
z ❑Removal Date Place Removed
and/or and/or Held
Hold Address
0
a Date Point of
U) ❑Transportation
p by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
I.- Remains are Shipped,If Other than Above
a Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/22/2020 Registrar of Vital Statistics Cynthia 'Ban/in(E(ectronica((y Signed)
(signature)
District Number 5726 Place Hudson Falls Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit ��•
~ 411.
Z Date of Disposition /pl 10 Place of Disposition
W
2 (address)
W
CC CC (section) aotnumber) (grave number)
Name of Sexton or Person in Charge of P emises �1'
(p/ea pr +."I
int/ °
W Signature Title 6 -
DOH-1555(07/18)p 1 of 2
r F
p.
Public Health Law Sec. 4145(2 4 4415 'E
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#