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PiazzaJr. Joseph NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Joseph Piazza Jr Male Date of Death Age If Veteran of U.S.Armed Forces, 11/25/2020 81 Years War or Dates 2 Place of Death Hospital,Institution or City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc Ww Undetermined ElPending Manner of Death © Natural Cause 0 Accident 0 Homicide 0 Suicide V Circumstances Investigation NU Medical Certifier Name Title G Carrie Miron PA Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 99 Burial Date Cemetery,Crematory or Facility Name a 11/27/2020 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury,New York ❑Donation Z ❑Removal Date Place Removed Fand/or and/or Held Hold Address ❑Transportation Date Point of by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address EiReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom t Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/27/2020 Registrar of Vital Statistics Aimee Mahoney(E(ectronica1Ty Signed) (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: // Date of Disposition 1f Z Z02v Place of Disposition el )e (>�e) Cii-to is au 2 (address/ W CA (section) (lot number) I (grave number) 8 Name of Sexton or Person in Ch a of Pre 'ses ia4//1,7.0Ne4 _E' 14 ci -, ('(p/ease print) Signature111 Title DOH-1555(07/18)p 1 of 2 ' Public Health Law Sec. 4145(2b) a �a Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#