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Aurelia, Thomas Nicholas
• # 3)b NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Thomas Nicholas Aurelia Male Date of Death Age If Veteran of U.S.Armed Forces, 03/25/2021 72 Years War or Dates 1969-1974 F Place of Death Hospital,Institution or Z City,Town or Village Schenectady Street Address Ellis Hospital ILI pManner of Death © Natural Cause ❑Accident 0 Homicide Suicide 0 Undetermined 0 Pending V Circumstances Investigation W Medical Certifier Name Title CI Shane Diamond MD Address 1101 Nott St,Schenectady,New York 12308 Death Certificate Filed District Number Register Number City,Town or Village Schenectady 4601 331 ElBurial Date Cemetery,Crematory or Facility Name 03/31/2021 Pine View Crematory ❑Entombment Address 0 Cremation Queensbury Town,New York ElDonation Z Removal Date Place Removed 0 and/or and/or Held i` Hold Address N 0 Date Point of N Li Transportation Shipment p by Common Carrier Destination 0 Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment 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 Name of Funeral Firm Making Disposition or to Whom 1.. Remains are Shipped,If Other than Above a Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/29/2021 Registrar of Vital Statistics Samanta R.Mykoo(Electronically Signed) (signature) District Number 4601 Place Schenectady, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on. II H n (lam Zio rt.,- Z Date of Disposition �I 1 I Z l Place of Disposition ► W (address) g !1JCC number) U) (section) (lot number/ (grave Name of Sexton or Person in Charge of P ises (plea print)/ W . �r Title [ Y��4 Signature DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 01 4 6 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#