Cortellessa Jr., Eugene J. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Eugene J.Cortellessa Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/18/2020 73 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Northumberland Town Street Address 2 Elm Street, Northumberland Town, New York 12831
p Manner of Death ❑X Natural Cause El Accident ❑Homicide ❑Suicide ❑Undetermined 1=1 Pending
W V Circumstances Investigation
W Medical Certifier Name Title
CI John Pezzulo DO
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Northumberland Town 4563 16
Burial Date Cemetery,Crematory or Facility Name
11/20/2020 Pine View Crematory
❑Entombment Address
0 Cremation Queensbury Town,New York
El Donation
Removal Date Place Removed
and/or and/or Held
H Hold Address
fA
0
d Date Point of
Cl) Li Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
ElDisinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
t— Remains are Shipped,If Other than Above
Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/20/2020 Registrar of Vital Statistics Dania,0 Mug*(EYectronica*Signe4
(signature)
District Number 4563 Place Northumberland Town, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
/ �
Z Date of Disposition !,2J_ap tr'
2U Place of Disposition ;J e J (*)t-co r t
2 (address)
W
CC CC (section) ,/ (lot number) a (grave number)
gName of Sexton or Person in Char of Premise Q7 �nv^�� �' 42�C
Z , / (please print/
W r Signature 0 /l�� Title ��peJZTyw'
DOH-1555(07/18)p t of 2
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Public Health Law Sec. 4145(2b) •.,f_
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#