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Musztacs, Jozef r NEW YORKSTATE DEPARTMENT OF HEALTH - Burial - Transit Permit Bureau of Vital Records :::_ Name First Middle Last Sex Jozsef Musztacs Male zab - Date of Death Age If Veteran of U.S.Armed Forces, `= 02/21/2021 89 Years War or Dates k+� Place of Death Hospital,Institution or IT City,Town or Village Glens Falls Street Address Glens Falls Hospital 'I Manner of Death ©Natural Cause p Accident ❑ Homicide ❑Suicide 0 Undetermined ❑Pending Circumstances Investigation tJ Medical Certifier Name Title Marvin Davidowitz MD ,i" Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number >' City,Town or Village Glens Falls 5601 112 ❑Burial Date Cemetery,Crematory or Facility Name 1-1 02/24/2021 Pine View Crematory ❑Entombment Address ElCremation Queensbury Town,New York 5 El Donation Q Date Place Removed Removal and/or and/or Held pzn Hold Address 0 Et Date Point of (0, ❑Transportation ES Common Shipment `', Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 ''1 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address t , W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/23/2021 Registrar of Vital Statistics gRpbertAndrew Curtis(ECectronica1ySigner) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition Z^Z,y_2p•L1 Place of Disposition p, , 6 '',e_.v+.,>�y X (address) Rl CI!kr (section) (lot number) (grave number) Name of Sexton or Pers in C arge of Premises J w l t�� �� '�-vl'''� z (p/ease print) Signature Title C re'»'/ ahvy ( e,�4,4/ DOH-1555(07/18)p10 2 /'r Public Health Law Sec. 4145(2t) 5 ( Receipt { Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#